I 







LIBRARY OF CONGRESS. 
fehelfJ? 



UNITED STATES <*F AMERICA. 





A TEXT-BOOK 



HYGIENE 



A Comprehensive Treatise on the Principles and 
Practice of Preventive Medicine from an 
American Standpoint. 



GEORGE H. ROHE, M. D. ( 



PBOF. OF HYGIENE, COLLEGE OF PHYSICIANS AND SURGEONS, BALTIMORE \ MEMBER OF 
AMERICAN PUBLIC HEALTH ASSOCIATION; OF THE AMERICAN DERMATOLOGICA I, 
ASSOCIATION ; OF THE MEDICAL AND CHIRUKGICAL FACULTY OF MARYLAND I 
CORRESPONDING MEMBER OF THE NEW ORLEANS ACADEMY OF 



a 



■7 



SCIENCES, ETC. 




BALTIMORE : 

THOMAS & BtAHS 



PREFACE. 



The aim of the author in writing this book has 
been to place in the hands of the American student, 
practitioner, and sanitary officer, a trustworthy guide 
to the principles and practice of preventive medicine. 

He has endeavored to gather within its covers the 
essential facts upon which the art of preserving health 
is based, and to present these to the reader in clear 
and easily understood language. 

The author cannot natter himself that much in the 
volume is new. He hopes nothing in it is untrue. 



TABLE OF COI2TBI2TS. 



CHAPTER I.-Air, 



The composition and physical conditions of the atmosphere, 2-6. Influence of 
changes of atmospheric pressure on health, 6-9. Influence of changes of temperature 
on health, 9-10. Humidity of the atmosphere as connected with changes in health, 
10-12. The sanitary relations of changes in composition, and of impurities in the air, 
12-17. Sewer air, 17-19. Tests for impurities in the air, 19-22. Ventilation, 22-28. 

CHAPTER II.— Water, 29-57. 

Quantity of water required by human beings, 29-31. Sources of drinking water, 
precipiiation, rivers, lakes and ponds, springs, wells, distillation, 31-39. Qualities of 
good drinking water, 39-40. Impurities in water, 40-42 Diseases due to impure drink- 
ing water, 42-51. Storage and purification of water, 51-53. Tests for impurities in 
water, 53-55. Signification of various impurities in water, 55-57. 

CHAPTER in.— Food, 58-87. 

Quantity and character of food necessary, 58-62. Foods, 62-63. Foods of animal 
origin, 63-73. Foods of vegetable origin, 73-76. Cooking, 76-79. Beverages containing 
alcohol, 79-84. The alkaloidal beverages, 84-86. Tobacco, 86-87. 

CHAPTER IV.-Soil, 88-102 

Physical and chemical characters of the soil, 88-89. The atmosphere of the soil, 
or ground-air, 89-94. The water of the soil, or ground-water, 94-96. Diseases spread 
by soil impurities, 96-99. Diseases of animals due to soil impurities, 99-101. Drainage, 
101-102. 

CHAPTER V.— Removal op Sewage, 103-119. 

Quantity of sewage to be removed, 103-104. The privy and privy-well systems, 104- 
107. The Rochdale, or pail-closet system, 1P7-110. Earth and ash closets, 110-111. 
The pneumatic system of Liernur, 111-113. The water-carriage system, 113-117. Final 
disposal of sewage, 118-119. 

CHAPTER VI.— Construction op Habitations, 120-141. 

Influence of insanitary dwellings upon health and life, 120-122. Site, 122. Charac- 
ter of soil, 122-127. Materials for construction of dwellings, 127-129. Size of rooms, 
and ventilating and heating arrangements, 129-130, Internal wall coating, 130. Light- 
ing, 130-132. Water-supply, 133. House drainage, 133-134. Water-closets, 134-137. Water- 
supply for closets, 137. Traps, 137-138. The soil-pipe, 138-139. The house-drain, 139- 
140. Official supervision of the sanitary arrangements of dwellings, 140-141. 

CHAPTER VII.— Construction op Hospitals, 142-153. 

Site, 142. The buildings, 142-145. Ventilation and heating, 115-147. Interior ar- 
rangements, 148-150. Administration and management of a general hospital, 151-153. 

CHAPTER VIII.— Schools, 154-164. 

Construction of school-houses, 154-157. School furniture, 157-158. Amount of time 
to be devoted to study, 168-159. Diseases of school-children, 160-164. 



Till TABLE OF CONTENTS. 

CHAPTER IX.— Industrial Hygiene, ; 165-189. 

Relation of occupations to health and life, 165-168. Occupations prejudicial to 
health, 168. Diseases due to the inhalation of irritating or poisonous gases or vapors, 
169-179. Diseases due to the inhalation of irritating or poisonous dust, 179-183. Dis • 
eases due to the absorption or local action of irritating or poisonous substances, 183- 
186. Diseases due to the excessive use of certain organs, 187-188. Diseases due to 
a constrained attitude and sedentary life, 188. Diseases from exposure to mechanical 
violence, 188-189. 

CHAPTER X.— Military and Camp Hygiene, 190-199. 

The soldier and his training, 190-191. The food of the soldier, 191-192. The cloth- 
ing of the soldier, 192-193. The dwelling of the soldier, barracks, tents and huts, 193- 
195. Camp diseases, 195-198. Civilian camps, 198-199. 

CHAPTER XI.— Marine Hygiene, 300-208. 

The sailor and his habits, 200-202. The passenger, 202-203. The ship as a habita- 
tion, 203-206. Diseases on shipboard, 206-208. 

CHAPTER XLT— Prison Hygiene, 209-213. 

Classification of prisoners, 209-210. Mortality of prisoners, 211. Diseases of pris- 
oners, 211-212. Punishments, 213. 

CHAPTER XIII.— Exercise and Training, 214-218. 

Physiological effects of exercise, 214-215. Physical training, 215-217. Over-exer- 
tion, 217-218. 

CHAPTER XIV— Baths and Bathing, 219-226. 

Varieties of baths, 219-221. Rules for bathing, 221-222. Dangers of cold bathing, 
222. How to restore the apparently drowned, 223-225. Public baths. 225-226. 

CHAPTER XV.-Clothing. 227-230. 
Clothing materials, 227-230. How to make clothing non-inflammable, 230. 

CHAPTER XVJ.— Disposal of the Dead, 231-235. 

Interment, 231-233, Supposed dingers of burial grounds. 233-234. Entombment in 
vaults, 234-235. Interment on the battle field, 235. 

CHAPTER XVII.— The Germ Theory of Diseases, 236-239. 

CHAPTER XVTII.— Contagion and Infection, 240-242. 

CHAPTER XIX.— History of Epidemic Diseases, 243-297. 

The oriental plague, 243-24S. The sweating sickness. 248-250. Small-pox, 250-266. 
Asiatic cholera, 866-376. Relapsing fever. 877-878. Typhoid fever, 278-280. Typhus 
fever, 2S0-281. Yellow fever, 281-2S4. Scarlet fever and measles, 884-385. Diphtheria, 
285-287. Dengue, 2S7-288. Epidemic influenza, 28S-2S9. Epidemic cerebro-spinal men- 
ingitis, 289-291. Syphilis, 291-294. Diseases of animals communicable to man;. sheep- 
pock, actinomycosis, bovine tuberculosis, rabies, anthrax, glanders, 291-297. 

CHAPTER XX.- Antiseptics and Disinfectants, 29S-303. 

Comparison of antiseptics and disinfectants, 896-899. Relative germicidal power of 
different agents, 299. Resistance offered to the action of disinfectants bv different 
organisms, 301. Methods of disinfection. 306. Antiseptic*. 308. 



TABLE OF CONTENTS. IX 

CHAPTER XXI.— Quarantine, 80M08. 

Objects of quarantine, 304-305. Modern notion of quarantine. 805-308, 

CHAPTER XXH.-Vital Statistics, 309-314. 

Registration of deaths, 309-310. Registration of births, 310. Registration of mar 
riages, 311. Registration of diseases, 311. Death-rate and birth-rate, 312-314. 



ComtECTioN :— On page 169, 'sulphuric acid gas' should read sulphurous acid yas. 



TEXT-BOOK OF HYGIENE. 

CHAPTER I. 

A I R. 

Exact investigation into the influence of the at- 
mosphere npon health is yet in its infancy. Enough 
has been learned, however, to show that changes in the 
composition of the air, in its density, its temperature, 
its humidity, its rate and direction of motion, and pos- 
sibly its electrical or magnetic conditions, influence in 
various ways the health of the individual. It is only 
very recently that any scientific attempts have been 
made to trace the bearing of atmospheric changes upon 
health. The observations already recorded indicate 
that a thorough study of meteorological phenomena in 
connexion with the origin and progress of certain dis- 
eases, is a promising field of labor for the educated 
sanitarian. The meteorological observations which 
have been gathered by the United States Signal Service 
during the past thirteen years, already form such a 
large and tolerably complete and well-arranged body of 
facts, that reasonably accurate deductions can even now 
be made. Heretofore, in studying the sanitary rela- 
tions of the atmosphere, both in this country and 
abroad, the attention of observers has been riveted 
almost exclusively upon the changes in its composition 
occurring within certain limited areas. It is, perhaps, 
equally important to study this universally diffused 
and necessary condition of vital activity in its broader 
and more general relations. It will be shown in the 
course of the present work, that the meteorological 
features of countries, or of seasons, or even the daily 
atmospheric changes, exercise an important influence 



a TEXT-BOOK OF HYGIENE. 

upon life and health. In order to fully appreciate 
these relations it will be necessary to first give a brief 
summary of the facts and laws of meteorology. 

THE COMPOSITION AND PHYSICAL CONDITIONS OF 
THE ATMOSPHERE. 

Atmospheric air is a mixture of four-fifths of nitro- 
gen and one-fifth of oxygen ; more accurately 79.00 of 
the former, to 20.96 of the latter. In addition, there 
is constantly present a modicum of carbonic acid, 
usually about .04 per cent., (3 to 5 parts in 10,000), 
and a variable proportion of vapor of water. 

These proportions are maintained, with very little 
change, at different heights. At first thought, it 
would seem that carbonic acid, being much heavier 
than the other constituents of air, would accumulate in 
the lower regions of the atmosphere, but in obedience 
to the law of diffusion, the intermingling of the com- 
ponent gases is perfect, and the proportion of carbonic 
acid in the atmosphere is quite as great on mountain- 
tops as in the deepest valleys. 

The proportion of nitrogen in atmospheric air is 
generally uniform, while that of oxygen varies, de- 
pending to a great extent upon the amount of carbonic 
acid present. Hence an increase in the amount of the 
latter constituent is usually accompanied by a diminu- 
tion of oxygen, inasmuch as the formation of carbonic 
acid can only take place at the expense of oxygen. 
The reciprocal activities of animal and vegetable life 
are beautifully illustrated by these relations between 
the oxygen and carbonic acid in the air. In the pro- 
cesses of combustion and oxidation, oxygen is" with- 
drawn from the atmosphere and combines with carbon, 
forming carbonic acid. During vegetable growth, on 
the other hand, carbonic acid is withdrawn from the 
air by the leaves of plants, and decomposed into its 



elements, carbon and oxygen. The carbon is used in 
building up the plant, while the liberated oxygen is 
restored to the atmosphere. The animal consumes oxy- 
gen and gives out carbonic acid ; the plant resolves this 
compound into its constituent elements and gives back 
the oxygen to the air again. 

The atmosphere extends upward from the surface 
of the earth to an indefinite distance. The limit has 
been variously placed at from forty-five miles to twenty- 
five thousand miles. In obedience to the law of gravity, 
this mass of air everywhere presses directly down- 
ward — toward the earth' s centre — with a force equal to 
its weight. If a column of this air be balanced by a 
column, or mass of any other matter — the columns 
being of the same diameter — we have a relative measure 
of the weight of the atmosphere. The instrument with 
which the weight, or downward pressure of the air is 
measured, is called a barometer. The atmosphere, at 
the sea-level, presses downward with a force equal to the 
pressure of a column of mercury thirty inches high. 
Hence, the barometric pressure at sea-level is said to be 
thirty inches. If the barometer be carried to the sum- 
mit of a mountain one thousand feet above the level of 
the sea, or taken to the same altitude in a balloon, the 
mercury in the barometer tube will fall about one inch. 
This inch of the mercurial column represents the 
weight of the one thousand feet of air now below the 
barometer, and consequently not measured or balanced 
by it.* 

Upon ascending from the sea-level, it is found also 
that the air, being less pressed upon by that which is 
still above it, becomes more rarefied and lighter ; its 
tension, as it is termed, is less. Hence, for the second 
thousand feet of ascent above the sea, the mercury will 

* The figures here given are not absolute, but merely approximate. The limits 
of this work do not allow a full discussion of the meteorological elements modifying 
the pressure of the atmosphere at sea-level. 



4 TEXT-BOOK OF HYGIENE. 

fall a less distance in the tube, the weight removed not 
being so great as in the first thousand feet. 

Variations in temperature and humidity of the air 
influence the tension of the atmosphere in a marked 
degree, and affect the height of the barometric column. 
In fact, most of the changes of atmospheric pressure at 
the surface of the earth, are directly due to changes in 
temperature and humidity. Increase of temperature 
diminishes the density of the air. Hence, when the 
temperature rises, the pressure decreases. The propor- 
tion of moisture (aqueous vapor), if increased, like- 
wise causes a diminution in pressure. 

The warmth of the air is primarily derived from 
the sun. On a clear day about one-fourth of the heat 
of the sun's rays is given off directly to the air during 
the passage of the heat-rays to the earth. Of the re- 
maining three fourths, part is reflected from the earth, 
while the larger portion is first absorbed by the earth 
and then given off by radiation and convection to the 
superincumbent air. 

The air is always warmer near the earth' s surface 
on a clear, sun-shiny day ; for, as soon as the earth gets 
warmer than the air immediately above it, the excess of 
heat is given off to the latter by convection and radia- 
tion. On ascending from the surface of the earth the 
temperature decreases, and on the summit of a high 
mountain, the air is always colder than at its base. 

Prof. Tyndall has shown that dry air does not ab- 
sorb heat. For this reason, the sun's rays strike the 
earth with much greater intensity on a very dry than 
on a moist day, while on the latter a larger proportion of 
the heat rays is intercepted before they reach the earth. 

Air at different temperatures is capable of absorb- 
ing different amounts of aqueous vapor. Thus, air at a 
temperature of 40° will require a much smaller amount 
of vapor to produce saturation than air at a tempera- 



ture of 80°. For this reason air which appears 'damp' 
at the former temperature, both to the bodily sensa- 
tions and to appropriate instruments, would be consid- 
ered as 'dry' at the latter temperature, although the 
actual amount of vapor present, or absolute humidity, 
is the same in both cases.* In meteorological observa- 
tions for sanitary purposes, the relative humidity is 
the condition deserving especially careful study. 

The motion of the air — wind — is caused by differ- 
ences in pressure ; the latter being due to differences in 
temperature and humidity. A mass of air traversing a 
large body of water absorbs vapor, unless already sat- 
urated, and becomes moist ; if it passes over a wide 
tract of dry land it loses moisture and becomes dry. 
Therefore in the eastern portion of the American con- 
tinent, an easterly or southerly wind which comes from 
over large bodies of water, and which is usually warm, 
and thus capable of holding a large quantity of water 
in a state of vapor, is always moist. On the other 
hand, a northerly or westerly wind, coming over a large 
extent of dry land and from a colder region, is nearly 
always a dry wind. On the Pacific coast these condi- 
tions are reversed ; there a westerly wind is a moist 
wind, while an easterly wind is dry. It is probable 
that the direction and rate of motion of air- currents 
have considerable influence upon the origin or intensi- 
fication of certain diseases. 

The electrical and magnetic conditions of the at- 
mosphere have been as yet studied to little advantage. 
It is only known that atmospheric electricity is in 
most cases positive, and that its intensity increases 

* By 'absolute humidity' is meant the total amount of vapor present in a cer- 
tain mass of air. By the term 'relative humidity' meteorologists designate the pro- 
portion of vapor present at certain temperatures, compared with full saturation of 
the air with vapor, which is reckoned 100. Thus, air which is saturated, or whose 
relative humidity is 100 at 40°, would have a relative humidity of only 24, if the tem- 
perature were raised to 80°, because in the latter case the capacity of the air for 
aqueous vapor is increased. Relative humidity is always designated in percentages ; 
absolute humidity in grains per cubic foot. 



6 TEXT-BOOK OF HYGIENE. 

with condensation of vapor. There seems to be no 
doubt that the varying states of atmospheric electricity- 
are closely connected with evaporation and condensa- 
tion. There is reason to believe that a fuller knowl- 
edge on these topics will yield most important results 
to the student of hygiene. 

The presence of ozone in the atmosphere has a very 
decided interest to the sanitarian. This modified form 
of oxygen which was discovered by Schcenbein in 1839, 
is formed wherever there is oxidation without a very 
high temperature. * What functions ozone performs in 
the air except as an oxidizing agent, is not known. 
An impression prevails largely that it has an import- 
ant bearing upon the causation of disease, but too little 
is known upon the subject to form the basis of a rational 
theory. 

The presence of ozone is detected by test paper, the 
best being Schcenbein' s, prepared as follows : Add ten 
parts of starch to two hundred parts of pure water ; 
heat it until the starch gelatinizes, and then dissolve 
one part of potassium iodide in the mixture. This 
paste is then spread on unsized paper and rapidly dried 
without exposure to sunlight. The paper is then kept 
in a dry, dark place, until wanted for use.f 

INFLUENCE OF CHANGES OF ATMOSPHERIC PRESSURE ON 
HEALTH. 

The effects of a considerable diminution of pres- 
sure are familiar to every one in the 'mountain sickness' 
which attacks most persons on ascending high moun- 
tains. M. Bert has shown experimentally that similar 
effects can be produced in an air-tight chamber by dimin- 
ishing the pressure.:}: The symptoms produced under a 

* R. C. Kedzie : On Ozone. Third Annual Report of the Michigan State Board 
of Health, I8T5, p. 137.— On Ozone and Atmospheric Electricity, see an instructive 
paper by the late Dr. George M. Beard, in Popular Science Monthly, Vol. IV., p, 450. 

t See Kedzie, above Quoted, p. 143. 

+ Popular Science Monthly, V., p. 379. 



pressure equivalent to an altitude of from 13,448 feet, 
to 16,728 feet, were a feeling of heaviness, nausea, ocu- 
lar fatigue, rapidity of pulse and convulsive trembling 
on slight exertion, and a sensation of languor and gen- 
eral indifference to the surroundings of the individual. 
M. Lortet, who has left on record his experiences 
in the higher Alps, says that the symptoms noticed on 
ascending to high altitudes are labored respiration, 
increased rapidity of pulse, depression of temperature, 
(as much as 4°-7° C). The normal temperature was 
restored, however, after a brief rest. * Still more severe 
symptoms have been noticed on ascending high moun- 
tains in South America and Asia. Aeronauts have lost 
consciousness, and in several instances life, on rapidly 
ascending to great altitudes, f According to the obser- 
vations of the brothers Schlagintweit, distinguished 
explorers of the highlands of Asia, the effects of dimin- 
ished pressure upon the human organism are : ' head- 
ache, difficulty of respiration, and affections of the 
lungs,— the latter even proceeding so far as to occa- 
sion blood-spitting, want of appetite and even nau- 
sea, muscular weakness, and a general depression and 
lowness of spirits. All these symptoms, however, dis- 
appear in a healthy man almost simultaneously with his 
return to lower regions.' A singular observation was 
made by these travelers on the effect of motion of the 
air upon the symptoms described. They say : ' The 
effects here mentioned were not sensibly increased by 
cold, but the wind had a most decided influence for the 
worse upon the feelings. . . . When occupied with 
observations, we took very little, if any bodily exercise, 
sometimes for thirty- six hours ; it would frequently 
occur nevertheless, even in heights not reaching 17,000 
feet, that an afternoon or evening wind would make us 

* Real-Encyclop£edie d. ges. Heilk. V., p. 529. 

t MM. Sivel and Croce-Spinelli, two asronauts, lost their lives in this manner 
during an ascent from Paris, in April, 1875. 



8 TEXT-BOOK OF HYGIENE. 

all so sick as to take away every inclination for food. 
No dinner was cooked; the next morning when the 
wind had subsided, the appetite was better. 

'The effects of diminished pressure are consider- 
ably aggravated by fatigue. It is surprising to what 
degree it is possible for exhaustion to supervene ; even 
the act of speaking is felt to be a labor, and one gets as 
careless of comfort as of danger. Many a time our 
people, — those who ought to have served us as guides 
— would throw themselves down upon the snow, declar- 
ing they would rather die upon the spot than proceed 
a step further.'* 

These symptoms disappear when persons are ex- 
posed to these conditions for a prolonged time. Thus, 
in the Andes there are places thirteen and fourteen 
thousand feet above sea-level, which are permanently 
inhabited ; and in the Himalayas there are villages at a 
height of over 15,000 feet constantly occupied. In this 
country, Pike's Peak, 14,150 feet above the sea, has 
been occupied since 1873 by observers of the signal ser- 
vice. The men seem to become acclimated, as it were, 
and suffer little or no inconvenience f rbm the diminished 
pressure, after a time. 

The effects of increased pressure of the atmosphere 
are especially manifested in divers, and in workmen in 
deep mines and tunnels. The symptoms are decrease 
of respiration, diminution in frequency of the pulse, 
ringing in the ears, earache, headache, mental depres- 
sion and sometimes actual deafness. 'When the work- 
men leave the compressed air, they are said to suffer 
from hemorrhages and occasional nervous affections, 
which may be from cerebral or spinal hemorrhages, 'f 
The workmen, however, soon become habituated to these 

* Results of a Scientific Mission to India and High Asia. By Hikmaxx, Adolphe 
and Robert De Schlagintweit. Vol. n., pp. 484-5. 

t Pakkes' Practical Hygiene, 6th ed., New York. Vol. H., p. 92. 



changes and then suffer little inconvenience upon expo- 
sure to the increased pressure. 

INFLUENCE OF CHANGES OF TEMPERATURE ON HEALTH. 

Many of the derangements of health ascribed to 
high temperature are to a considerable degree due to 
other factors, prominent among which are high humid- 
ity, intemperance, overwork and overcrowding. There 
can be little doubt, however, that the importance of the 
high temperature itself can hardly be overrated. It has 
been generally accepted heretofore that a high temper- 
ature together with a high relative humidity is most 
likely to be followed by sunstroke. A careful compar- 
ison in a series of deaths from sunstroke in the city of 
Cincinnati in the summer of 1881, shows, however, con- 
clusively, that a very high mean temperature with a 
low relative humidity is more liable to be followed by 
sunstroke than the high temperature when accompanied 
by a high humidity. The same series of observations 
also shows that the number of deaths was greater on 
clear days than on cloudy or partly cloudy days.* A 
corroboration of this result is found in the fact that 
sunstrokes very rarely occur on shipboard, at sea, 
where the relative humidity is always high. 

Diarrhceal diseases, both of adults and children, 
are much more frequent during hot than during cold 
weather, (and in hot than in cold climates), but it is 
probable that other factors aid in the production of 
these diseases beside the high temperature. 

Certain epidemic diseases are likewise more fre- 
quent in, or exchisively confined to, hot climates. 
These are cholera, yellow fever and epidemic dysentery. 
Elephantiasis and the prevalence of certain skin dis- 
eases seem also to have some connexion with a con- 
stantly high external temperature. The intimate rela- 

* A. J. Miles : The Sunstroke Epidemic of Cincinnati, O., during the Summer 
of 1881. Public Health, Vol. VII., p. 293-304. 



10 TEXT-BOOK OF HYGIENE. 

tion between cause and effect is not clearly understood, 
although the belief is current that the origin and spread 
of such diseases depend upon the development of varU 
ous parasitic organisms. 

Extreme low temperature, as observed in the arctic 
regions, seems to produce a progressive deterioration of 
the blood, (anemia), " in consequence of which most 
natives of temperate regions who are compelled to 
remain in the far north longer than two winters, suc- 
cumb to various hemic diseases, scurvy being the most 
prominent. It is not improbable, however, that the 
dietary furnished is responsible for a large share of the 
evil effects ascribed to cold. The absence of sunlight 
for a considerable part of the winter season, may also 
have much to do with the bad influences for which the 
low temperature is held responsible. 

Among the acute effects of great cold, frost-bite is 
the most frequent, as well as the most serious. Loss 
of portions of the nose, or ears, or even of entire mem- 
bers are not infrequent results of frost-bite. 

In the arctic regions, one of the most annoying 
affections which the traveler has to contend against, is 
snow-blindness, a severe ophthalmia produced by the 
glare of the snow. Neutral tinted glass goggles should 
be worn as a preventive.* 

HUMIDITY OF THE ATMOSPHEEE AS CONNECTED WITH 
CHANGES IN HEALTH. 

The propagation of certain acute infectious diseases 
is believed to be due to a high relative humidity. 
There can be no longer any doubt that a very humid 
soil and air, especially if connected with a variable 
temperature, are almost constant factors in the produc- 

* See Pater's Narrative of the Austrian Arctic Voyage of 1872-74, p. 250-3 and 
317, for an account of the effects of cold on the organism, and on the best prophy- 
lactic measures to be adopted. The Report of the Surgeon General of the V. S. Navy 
for 1880, also contains (pp. 350-8> a valuable memorandum by Surgeon-General Philip 
S. Wales, on Arctic Hygiene. 



AIR. 11 

tion of pulmonary phthisis. Recent experience in this 
country and abroad has shown that the high plateaus 
and mountains, far inland, where the soil is dry and 
the relative humidity of the air low, are the best resorts 
for consumptives. 

Of the effects of excessively dry air on health, 
little definite is known. It seems probable, however, 
that catarrhal affections of the respiratory mucous 
membrane are more frequent in a dry than in a humid 
climate. 

With reference to the influence of electrical condi- 
tions of the atmosphere upon health, no observations 
have been made which admit of definite conclusions 
being reached.* 

Mr. Alexander Buchan and Dr. Arthur Mitchell 
have analyzed the influence of the weather and season 
upon the causation of disease, or rather upon the mor- 
tality from various diseases, f Taking the records of 
the city of New York from 1871 to 1877, it appears that 
the maximum number of deaths from small-pox oc- 
curred in May, the minimum in September. From 
measles there were two annual maxima and minima, 
the greater in July and September, and the smaller in 
February and April. From scarlet fever the maximum 
was in April, the minimum in September. From 
typhoid fever the maximum was from August to Novem- 
ber, the minimum almost equally distributed through- 
out the rest of the year. From diarrhoea, the maxi- 
mum in July and August, the minimum from Decern - 

* Dr. S. Weir Mitchell has shown (from the record of the case of Gapt. Catlin, 
U. S. A., see American Journal Med. Sci., April, 1877, and N. T. Med. Jour., Aug. 25, 
and Sept. 1, 1883), that attacks of neuralgia, in this case at all events, accompanied 
the progress of storms across the continent. Also, that the periods of maximum pain 
occurred with a high but falling barometer and increasing absolute humidity. There 
seems also to be some relation in this case between the maximum pain and the maxi- 
mum magnetic force as shown by the declinometer. Dr. Mitchell's papers are among 
the most valuable positive contributions to hygienic meteorology and deserve careful 
study. 

t Journal Scottish Meteorological Society, 1875-8. Abstract in Richardson's 
Preventive Medicine, Phila., 1884, p. 533, et seq. 



12 TEXT-BOOK OF HYGIENE. 

ber to March. From diphtheria the maximum in De- 
cember, the minimum in August.* From whooping- 
cough, maximum in September and February, mini- 
mum in November and June. For croup, the curves 
agree pretty closely with the diphtheria curves. From 
phthisis, the maximum in March, minimum in June. 
From suicide, curiously the greater number occurs in 
May, the smallest in February. This is contrary to 
the usual supposition that gloomy weather predisposes 
to suicide. In Philadelphia, the results of an examina- 
tion of the statistics of suicide for ten years are almost 
exactly similar. Out of 636 cases of suicide, 78 occurred 
in May, 71 in August, 57 in December, 54 each in Octo- 
ber, July and April, 52 in June, 49 in November, 44 
each in December and February, 43 in March, and 36 
in January. f Dr. Lee is led to believe 'that a low ba- 
rometric pressure, accompanied by a high thermometric 
registry, with sudden fluctuations from a low to a high 
temperature, together with much moisture and prevail- 
ing south-west winds, might somewhat account for the 
frequency of self-murder in the spring and summer 
months. ' 

THE SANITARY RELATIONS OF CHANGES IN COMPOSITION 
AND OF IMPURITIES IN THE AIR. 

The average proportion of carbonic acid in the 
atmosphere is from 3 to 5 parts in 10,000. Petten- 
kofer % places the maximum limit of carbonic acid 
allowable in the air of dwellings, at 7 parts in 10, 000. It 
is probable that this limit is very frequently exceeded 
without serious consequences to health, if the air is not 
at the same time polluted by organic impurities, the 

* See paper on the relation of weather to mortality from diphtheria in Balti- 
more. By Richard Henrt Thomas, in Trans. Med. and Chir. Faculty of Maryland, 18S3. 

t John G. Lee : Suicide in the City and County of Philadelphia during a decade, 
1872 to 1881 inclusive. Trans. Am. Med. Asso., Vol. 33, p. 425. 

X Quoted in Buck's Hygiene and Public Health, Vol. 1., p. 615. 



N AIR. 13 

products of respiration. Prof. William Ripley Nichols, 
found the air in a school-room in Boston to contain 
eight times the normal proportion of carbonic acid, 
while Pettenkof er found, also in a school-room, after the 
same had been occupied two hours, eighteen times the 
normai proportion, or 72 parts in 10,000.* While such 
an excess of this poisonous gas must unquestionably 
have an unfavorable influence upon health, it is proba- 
ble that the most serious effects are due to the coinci- 
dent diminution of oxygen and the pollution of the air 
by the products of respiration which necessarily take 
place during respiration. Carbonic acid alone may be 
present in the air to a much greater extent than above 
mentioned, without causing any appreciable inconve- 
nience. In the air of soda-water manufactories there 
is frequently as large a proportion as two per cent, of 
this gas present without producing any ill effects upon 
those breathing such an atmosphere. 

The amount of carbonic acid in the atmosphere is 
greatest at night. It is also greater very near the ground 
than at a distance of several feet above it. As carbonic 
acid is absorbed by the leaves of plants during the day- 
time, but given off at night, the difference may partly be 
thus accounted for. According to Fodor,f the source 
of a large proportion of the carbonic acid in the air, 
is the decomposition going on in the soil. This ac- 
counts for the larger percentage of carbonic acid near 
the ground. This would also explain the variation of 
the proportion of carbonic acid in the air under differ- 
ent meteorological conditions. For example, it is found 
that during rainy weather the carbonic acid in the air 
is diminished. This is accounted for partly by the ab- 
sorption of the carbonic acid by the saturated ground, 

* See table in Buck's Hygiene and Public Health, Vol. I., p. 612. 

t Fodor : Hygienische Untersuchungen ueber Luft, Boden und Wasser, Braun- 
schweig, 1882, 2te Abth. 



14 TEXT-BOOK OF HYGIENE. 

while at the same time the porosity of the soil is dimin- 
ished and the escape of the ground air prevented. 

Mr. R. Angus Smith made a number of experi- 
ments upon himself to determine the effects of an at- 
mosphere gradually becoming charged with the pro- 
ducts of respiration and perspiration. His experiments 
were conducted in a leaden chamber holding 170 cubic 
feet of air. This air was not changed during the exper- 
iment. After remaining for an hour in this chamber, 
an unpleasant odor of organic matter was perceptible 
on moving about. The air when agitated felt soft, ow- 
ing doubtless to the excess of moisture contained in it. 
The air soon became very foul, and although not pro- 
ducing any discomfort, the experimenter states that 
escape from it produced a feeling of extreme pleasure, 
like 'that which one has when walking home on a fine 
evening after leaving a room which has been crowded.'* 

Hammondf confined a mouse in a large jar in which 
were suspended several large sponges saturated with 
baryta water, to remove the carbonic acid as rapidly 
as formed. Fresh air was supplied as fast as required. 
The aqueous vapor exhaled was absorbed by chloride 
of calcium. The mouse died in 4.5 minutes, evidently 
from the effect of the organic matter in the air of the 
jar. The presence of this organic matter was demon- 
strated by passing the air through a solution of potas- 
sium permanganate. 

The horrible story of the -black hole' of Calcutta 
is familiar to every one. Of 146 prisoners confined in 
a dark cell at night, 23 were found alive in the morn- 
ing. Among the survivors a fatal form of typhus fever 
broke out, which carried off nearly all of them. After 
the battle of Austerlitz, 300 prisoners were crowded in 
a prison ; 260 died in a short time from inhaling the 

* Air and Rain, p. 138. 

+ A Treatise on Hygiene, with special reference to the Military Service. By Wsi. 
A. Hammond, JI. D.. Surgeon-General U S. Army. Philadelphia. 1863. p. 170. 



AIR. 15 

poisoned air. Numerous other similar examples of the 
effects of polluted air are recorded. 

Usually the effects of foul air are not so sudden 
and striking. In most instances, especially where the 
pollution has not reached a high degree, there simply 
results a general deficiency of nutrition, which mani- 
fests itsef in anemia, loss of vigor of body and mind, 
and a gradual diminution of resistance to disease. 

It seems to be beyond question that persons who are 
constantly compelled to inhale impure air, especially 
if combined with an improper position of the body, or 
lack of sufficient or appropriate food, furnish a very 
large percentage of chronic pulmonary affections. 
Phthisical patients, in the overwhelming majority of 
cases, are drawn from the classes whose occupations 
keep them confined in close rooms. Want of exercise, 
and of good food, doubtless aid in the development of 
the lung disease. Formerly, when less attention was 
paid to the proper construction and ventilation of bar- 
racks and prisons, the mortality from phthisis among 
soldiers and criminals was much greater than it is now. 
In animals kept closely confined, the same disease 
claims a large share in the mortality. 

Near the end of the last century, over one-third of 
the infants born in the old Dublin Lying-in Hospital, 
died of epidemic disease. After the adoption of an 
improved system of ventilation, the mortality fell to 
about one-tenth of what it had previously been. To 
illustrate the effect of similar conditions upon the health 
of domestic animals, the following instance is cited: 
Upward of thirty years ago, a severe epidemic of influ- 
enza in horses appeared in Boston. At the instigation 
of Dr. H. I. Bowditch, every stable in the city was 
inspected and classified, as 'excellent,' 'imperfect,' or 
'wholly unfit,' in respect to warmth, dryness, light, 
ventilation and cleanliness. It was found that in the 



16 TEXT-BOOK OF HYGIENE. 

first class fewer horses were attacked and the disease 
was milder, while in the third class every horse was 
attacked, and the more severe and fatal cases occnrred. 

Carbonic oxide gas is a very dangerous impurity 
often present in the air of living-rooms. Being an in- 
gredient of illuminating gas, as well as the so-called 
coal-gas, which so frequently escapes from stoves and 
furnaces, its dangerous character becomes apparent. 
Many persons die every year in this country from the 
inhalation of illuminating gas. People unacquainted 
with the mechanism of the gas-fixtures, frequently blow 
out the light instead of cutting off the supply of gas by 
turning the stop-cock. It is also a prevailing custom 
to keep the light burning ' low ' during the night. . Any 
considerable variation of pressure in the pipes, or sud- 
den draught, may put out the light and permit the gas 
to escape into the room with fatal effect. Leaks in the 
pipes or fixtures may have the same results. 

Coal, coke, or charcoal fires may produce serious 
or fatal poisoning, if the gas, which contains a large 
proportion of carbonic oxide, is permitted to escape 
into the room. In certain parts of Europe, notably in 
France, the inhalation of the fumes of a charcoal fire is 
a favorite method of committing suicide. 

Sulphuretted and carburetted hydrogen are not 
infrequently present in the air, especially about cess- 
pools, and in mines and certain manufacturing estab- 
lishments. Sulphuretted hydrogen is generally consid- 
ered to be a violent poison, but there is no evidence 
that it is so unless oxygen is excluded. 

Carburetted hydrogen is the so-called 'fire-damp' 
of mines, which is so often the cause of fatal explosions. 
Its inhalation does not seem to be especially noxious. 
It will be more fully referred to in a succeeding chapter. 

Variations in the proportion of ammonia present 
in the air are frequent. Its presence is an indication 



AIK. 17 

of organic decomposition in the vicinity, but nothing 
is known of the influence of the gas itself upon health, 
in the proportion in which it is ever found in the 
atmosphere. 

SEWER AIR. 

Sewer air, or sewer gas, as it is often improperly 
called, is a variable mixture of a number of gases, 
vapors, atmospheric air and solid particles, and is de- 
rived from the decomposition of the animal and vegeta- 
ble contents of sewers. A number of analyses by dif- 
ferent chemists have shown that the composition of 
sewer air is extremely variable. The most important 
components, in addition to the constituents of atmos- 
pheric air, are: carbonic acid, ammonia, sulphuretted 
hydrogen, and a number of volatile organic compounds 
which give to sewage its peculiar odor, but which are 
present in such small quantity as to prevent accurate 
determination by chemical means. Sewer air may also 
contain particulate bodies, bacteria and other micro- 
scopic organisms which are supposed by many to be 
the active causes of infectious diseases. 

When the contents of sewers remain in these re- 
ceptacles or conduits long enough to undergo decompo- 
sition, sewer air is always present. It is believed by some 
physicians and sanitarians that sewer air is the direct 
cause of such diseases as typhoid fever, scarlet fever, 
diphtheria and cholera, while others hold the view that 
the sewer air is merely a favorable breeding place for 
the germs of these diseases, and that it thus merely acts 
as a medium in which the infective agent grows, repro- 
duces itself, and is conveyed from place to place. There 
is no absolutely reliable evidence in favor of either 
of these doctrines. 

It is hardly open to question, however, that the 
continual breathing of air polluted by emanations from 



18 TEXT-BOOK OF HYGIENE. 

sewers often produces more or less serious derangements 
of health. Diarrhoea, and other intestinal affections, 
mild cases of continued fever, and even cases of un- 
doubted typhoid fever have been so frequently noted in 
connexion with defective sewerage, and the escape of 
sewer air into inhabited rooms, that doubt upon this 
point is hardly justifiable. With regard to typhoid 
fever, however, it is probable that the sewage in these 
cases contained the particular virus which causes this 
disease. 

The effluvia from cemeteries, knackeries, and other 
places where the bodies of animals are undergoing de- 
composition are, it is believed with good reason, dele- 
terious in their effect upon health. 

Prof. Tyndall has shown* that even the apparently 
clearest air is, when in motion, constantly filled with 
innumerable particles of dust, which are believed by 
many to give rise to various forms of disease. The 
presence of these particles can be easily demonstrated 
by means of the electric light. Everyone has observed 
these minute particles in a bright ray of sunlight. 
Under ordinary conditions these particles of dust would 
of course give rise to no trouble, but if intermingled 
with these dust specks there were disease germs — 
whether these germs be considered as living organisms, 
or as particles of dead tissue from the body, then man- 
ifestly the inhalation of such ' dust ' would be danger- 
ous. 

The quantity of dust found in the air of cities is 
much greater than in the country. Tissandier found 
that in Paris the percentage of dust was eight to twelve 
times greater than in the open country. One-fourth to 
nearly one-half of this atmospheric dust is organic, 
either animal or vegetable. Very recent observations 
have shown that in Paris the air contains nine or ten 

* Essays on the Floating Matter of the Air. New York, 1882. 






AIR. 19 

times as many bacteria in a given volume as the air at 
the observatory of Montsouris, just without the city. 

TESTS FOR IMPURITIES IN THE AIR. 

The sense of smell will indicate the presence of 
sulphuretted hydrogen, or of volatile organic matter. 
Chemical tests and the microscope will, however, be 
necessary to determine the presence of carbonic acid, 
carbonic oxide, or suspended particulate matter in the 
air. 

Tn order to detect the presence of carbonic acid, 
advantage is taken of the affinity of the acid for certain 
alkalies with which it forms insoluble compounds. If 
a stream of carbonic acid gas is passed through lime or 
baryta water, an insoluble carbonate of lime or baryta 
is instantly formed, and produces a milky precipitate 
in the water. If, instead of passing a stream of the 
gas through the liquid, the latter be agitated with air 
containing carbonic acid, a similar precipitate is pro- 
duced. The most exact method of determining the 
amount of carbonic acid in the air is that known as 
Pettenkof er' s, * but it is somewhat complicated. A 
readier method has been devised by Mr. Angus Smith, 
and is termed the minimetric test.f A series of six 
wide-mouthed bottles, having a capacity respectively 
of 450, 350, 300, 250, 200 and 150 cubic centimeters % is 
fitted with clean, tightly-fitting corks. The bottles are 
made perfectly clean and dry, and 15 cu. cm., (3f drams) 
of clear, fresh lime or baryta water put into the smallest, 
the cork replaced and the bottle well shaken. If the 
water becomes turbid there is at least .16 per cent (16 
parts per ten thousand) of carbonic acid in the air 
treated. If only the water in the largest bottle becomes 

* Nowak, Lehrbuch der Hygiene, p. 149. 
t Nowak, op. cit., p. 152. 

X The equivalents in English measures are : 14 oz., 11 oz.. 9^6 oz., 8 oz.. 6H oz., 
and 4% oz. 



20 TEXT-BOOK OF HYGIENE. 

cloudy, the proportion of carbonic acid is probably less 
than 5 parts in 10,000. For the intermediate series of 
bottles, the amounts of carbonic acid necessary to pro- 
duce cloudiness are respectively : for 200 cu. cm. of air, 
12 parts in 10,000; for 250 cu. cm., 10 parts; for 300 
cu. cm., 8 parts ; and for 350 cu. cm., 7 parts per 10,000. 
If therefore a cloudiness is produced with any of the 
bottles except the largest, the amount of carbonic acid 
present exceeds the standard allowable in pure air. 
The test should be frequently made, in order to acquire 
familiarity with its use. The same quantity of the test 
liquid is of course used in each bottle. 

Carbonic oxide is detected by its reaction with 
chloride of palladium, which gives a black color when 
brought in contact with the gas. If a strip of linen, 
or blotting paper be moistened with a solution of the 
palladium chloride (gr. j to 1 j), and suspended in air 
containing carbonic oxide, the black color will be de- 
veloped. The suspected air may also be passed through 
a solution of sodio-chloride of palladium, when the 
liquid will turn black, if carbonic oxide be present. 

The percentage of organic impurity in the air of an 
occupied room (products of respiration, etc.) is diffi- 
cult to ascertain directly. Pettenkofer has found, how- 
ever, that the proportion of carbonic acid present is 
indirectly a measure of the organic impurity from res- 
piration.* As the determination of the carbonic acid 
is easy by the minimetric method of Angus Smith, the 
extent to which the air is polluted by respiratory im- 
purities is readily ascertained. 

The presence of organic and other suspended impur- 

* Recent observations in this country (see Annual Reports of the Surgeon-General 
of the Navy for 1879, p. 45 and 46, and the same for 1880, p. 31-34.) seem to throw some 
doubt upon the entire reliability of this method of determining the amount of organic 
matter in the air examined. Prof. Ira Remsen CRept. Xat'l Board of Health, 1S79. p. 77, 
and 1880, p. 308, et seq.,)has shown the insufficiency of the chemical methods at present 
in use, and points out the difficulties of making reliable and satisfactory determinations 
of organic matter in the air. 



AIE. 21 

ities can be best demonstrated with a microscope. An 
objective magnifying upward of 400 linear diameters, 
and experience in the use of the instrument, will be 
needed to obtain correct results. By moistening a 
glass slide with glycerine, and exposing it in the sus- 
pected air, a sufficient quantity of the suspended 
matters may be collected in the course of twenty-four 
hours to permit some conclusions to be drawn from a 
microscopic examination. * 

A common method of determining the presence or 
absence of a large quantity of carbonic acid, for 
example, at the bottom of a well or privy- vault, is to 
lower a lighted candle to the bottom. If the light is 
extinguished, the air is considered irrespirable ; but 
if it continues burning brightly, the air is believed to 
be sufficiently pure to sustain life. Sulphuretted hy- 
drogen and sulphide of ammonium are sometimes found 
in privy- vaults, and although they will not extinguish 
a light, they speedily prove fatal if inhaled in a con- 
centrated form, and to the exclusion of a sufficiency of 
oxygen. Cases frequently occur where serious or fatal 
results have ensued from the presence of a dangerous 
gas, which was thought to be excluded by the burn- 
ing candle, f 

It is advisable in all cases to exhaust the stagnant 
air in all old wells and privy-vaults, before permitting 
any one to descend. Perhaps the readiest method of 
exhausting the vitiated air in such places would be to 
lower heated stones, masses of hot iron or pails of hot 
water, to near the bottom, which produce a rarefaction 
of the air and cause it to ascend. Its place will then 
be occupied by purer air from without. The raref ac- 

* Dr. G. M. Sternberg, TJ. S. A., (Rept. National Board of Health, 1880) gives an 
account of bis investigations into the suspended matters of the air. The question is 
also considered in a practical manner by Surgeons Kidder and Streets, U. S. N., in 
Reports of the Surg.-Gen'l of the Navy for 1880 and 1881. 

t See a case reported in Philadelphia Medical Times, October 21, 1882. 



22 TEXT-BOOK OF HYGIENE. 

tion produced by the explosion of gun-powder has also 
been made use of with success ; but this has some 
objections, because the combustion of powder itself 
produces gases which are noxious if breathed in large 
quantity. An animal, such as a cat or dog, should be 
first lowered into the suspected well for fifteen or 
twenty minutes, in order to determine whether the air 
at the bottom is capable of sustaining life, before per- 
mitting the workmen to descend. Similar precautions 
should be used in old, unused mines, to prevent fatal 
effects from the so-called 'choke damp' which is large- 
ly composed of carbonic acid. 

VENTILATION. 

It is generally accepted that the presence of .07 per 
cent, (seven parts in 10,000) of carbonic acid in the air, 
indicates the greatest amount of organic impurity 
(from respiration or combustion) consistent with the 
preservation of health. Adopting this as the standard 
of maximum impurity allowable, 3,000 cubic feet of 
fresh air per hour will be needed for each individual 
to keep him supplied with pure air. This is for j)ersons 
in a state of health ; in cases of disease, a more rapid 
change of air will be necessary to keep that surround- 
ing the patient in a state of purity. 

Ventilation is defined by Worcester, as 'the re- 
placement of noxious or impure air in an apartment, 
mine, or enclosed space, by pure fresh air from without. ' 
By Dr. Parkes the term is restricted to 'the removal 
or dilution, by a supply of pure air, of the pulmonary 
and cutaneous exhalations of men, and the products of 
combustion of lights in ordinary dwellings, to which 
must be added, in hospitals, the additional effluvia 
which proceed from the persons and discharges of the 
sick. All other causes of impurity of air ought to be 
excluded by cleanliness, proper removal of solid and 



liquid excreta, and attention to the conditions sur- 
rounding dwellings.'* 

A proper system of ventilation must take into con- 
sideration the cubic space of the apartment or building 
to be ventilated, the number of persons ordinarily 
inhabiting this space, and certain other collateral 
elements, such as the character of the building to be 
ventilated, its exposure, necessity for artificial heating, 
etc. 

The amount of cubic space that must be allowed to 
each individual is determined by the rapidity with 
which fresh air must be supplied in order to keep that 
surrounding the individual at the standard of less than 
.07 per cent, of carbonic acid. For example, in a 
space of 100 cubic feet, the air must be changed thirty 
times in an hour, in order to prevent the carbonic acid 
exceeding the above proportion, that is to say, to allow 
3,000 cubic feet of air to pass through that space in the 
time mentioned. This would create an uncomfortable, 
if not injurious draught. If the space contained 1,000 
cubic feet, the air would need renewal only three times 
an hour. 

A space of 500 cubic feet could be kept supplied 
with pure air without perceptible movement if all the 
mechanical arrangements for changing the air were 
perfect ; but such perfection is rarely attainable, and 
hence there would be either draughts, or insufficient 
ventilation in such a small 'initial air space,' as it is 
termed. The initial air space should, therefore, be not 
less than 800, or better, 1,000 cubic feet. The air of 
this space could be changed sufficiently often to keep it 
at its standard of purity, without creating unnecessary 
draught. For sick persons this should be doubled. 
In hospitals, therefore, the cubic air space allowed to 
each bed should not be less than 1,800 to 2,000 cubic feet. 

* Manual of Practical Hygiene. 6th edition, New York, Vol. I, p. 157. 



24 TEXT-BOOK OF HYGIENE. 

The source of the air supplied, must of course, be 
capable of yielding pure air. It should not be drawn 
from damp cellars or basements, or from the immediate 
vicinity of sewers, or drains. Air taken from such 
places is little better for respiration than that which it 
replaces in the apartments to be ventilated. 

Ventilation may be accomplished either with or 
without artificial aids. In buildings or rooms, used as 
habitations, natural ventilation, with, perhaps, the 
simplest mechanical aids are made use of almost en- 
tirely. In large buildings, such as churches, theatres, 
schools, or in ships and mines, one of the artificial 
systems must be adopted if efficient ventilation is 
desired. 

Natural ventilation takes place by diffusion, by 
perflation, and in consequence of inequality of atmos- 
pheric pressure. By diffusion, is meant the slow and 
equable entrance of air from without, and exit from 
within a room through the walls or ill-made joints, 
without the influence of wind currents. In an occupied 
room this is, however, insufficient to keep the air pure, 
because many of the organic impurities of respired air 
are molecular, and, therefore, incapable of making 
their way out of the rooms through the walls. 

Perflation means literally, 'blowing through,' and 
if the direction and force of air-currents could be reg- 
ulated, this would, with simple mechanical arrange- 
ments, be an efficient means of ventilation. However, 
the uncertainty of the force and direction of the wind 
make this method of ventilation unreliable, except in 
warm weather. 

Unequal pressure between the air in a room, and 
that without, is, within certain limits, an efficient means 
of ventilation, and is usually relied upon in ordinary 
apartments. When the air in a room is heated above 
the temperature of the external air. either by a fire > 



AIR. 25 

lights or by the presence of a number of persons in the 
room, it expands . and part of it finds its way out 
through numerous crevices and bad joints found in all 
buildings. The air which remains, being less dense than 
the external air, the latter enters the room by various 
openings, until the equality of pressure is re-estab- 
lished. But as the heating of the enclosed air contin- 
ues, the process is momentarily repeated and becomes 
continuous. 

Although the impurities of respired air (carbonic 
acid, organic matters), are heavier than the air itself at 
the same temperature, it is a familiar fact that the 
most impure air in "an occupied room is always found 
near the ceiling, the impurities being carried upward 
with the heated air, and that the pure air from with- 
out, being colder, fills the lower part of the room. 

If the cold, outside air, were to be admitted at the 
bottom of the room, and means allowed for the escape 
of the hot air at the top, the conditions of the old 
health-maxim, to 'keep the feet warm and the head 
cool,' would be reversed. This would be no less un- 
comfortable than unwholesome. In all plans for nat- 
ural ventilation, therefore, provision must be made to 
secure a gradual diffusion of the cold, outside air from 
above, or to have it warmed before it enters the room. 
With a large chimney as an aspirating shaft,* with 
flues at the top and bottom of the room, and openings 
in the walls of the room near the ceiling to admit fresh 
air, sufficient ventilation can be usually secured in cold 
weather, in a room not overcrowded. 

When a room is heated by a furnace, the fresh air 
is warmed before it is introduced, and the foul air es- 
capes either through a ventilating shaft, a ventilator 

* Of course there is really no such thing as a real aspiration, or 'sucking out' 
of the air through the chimney or so-called 'aspirating shaft.' The upward movement 
of the air in the shaft is due to its displacement by the colder or denser air entering 
the room. 



26 TEXT-BOOK OF HYGIENE. 

in the window, or wall, or through the numerous fis- 
sures and other orifices, which defective carpentering 
always leaves for the benefit of the health of the oc- 
cupants. 

The following rules for the arrangement of a sys- 
tem of natural ventilation, are modified and condensed 
from Parkes :* 

The apertures of entrance and of exit for the air 
should be placed far enough apart to permit thorough 
diffusion of the fresh air. 

When the air is brought into a room through slits 
or tubes in the walls near the ceiling, the current 
should always be deflected upward by an inclined 
plane, in order to prevent a mass of cold air from 
descending over the shoulders of the occupants and 
chilling them. 

The air must be taken from a pure source. 

The inlet tubes should be short, and so made as to 
be easily cleansed, otherwise dirt lodges and the air 
becomes impure. 

Inlets should be numerous and small, to allow a 
proper distribution of the entering air. 

Externally, the inlets should be partially protected 
from the wind to prevent strong draughts ; they should 
also be provided with valves to regulate the supply of 
air. 

If the air cannot be warmed, the inlets must be 
near the ceiling ; if it can be heated, it may enter near 
the floor. 

The air may be warmed by passing it through 
boxes containing hot water, or steam coils ; by passing 
it through chambers around grates or stoves, or heating 
it in a furnace. 

In towns or manufacturing districts, the air should 
be filtered before allowing it to enter the room. Thin 

* Manual of Practical Hygiene, (ith ed.. New York. Vol. I. p. 177. 



aii:. 27 

flannel or muslin spread over the openings answers very 
well as filtering material. 

Outlets should be placed at the highest point of the 
room and should be protected from the weather. An 
opening into the chimney near the ceiling will answer 
well in many cases. 

In one story buildings, ridge- ventilators make the 
best outlets. The entrance of snow and rain must be 
prevented by suitable arrangements. 

A small space or slit between the horizontal bars of 
the upper and lower window sash will admit sufficient 
air in a proper direction in small rooms, even when the 
window is shut. 

A good arrangement is one devised by Dr. W. W. 
Keen, of Philadelphia.* A piece of stout paper or 
cloth is tacked across the lower ten or twelve inches of 
the window frame. Raising the lower sash, allows the 
entrance of fresh air, which is directed upward by the 
cloth obstruction. 

In all rooms, howsoever ventilated, doors and win- 
dows should be often opened to permit a thorough 
flushing of the interior with fresh air. 

For large buildings, hospitals, schools, theatres, 
ships, and mines, two systems of artificial" ventilation 
are in use. One operates by extracting the foul air by 
means of fans, the other, by forcing in fresh air, allow- 
ing the impure air to find its way out as best it may. 

In some of the vessels of the IT. S. Navy a system 
of ventilation is in use, for the details of which the au- 
thor is indebted to Dr. A. L'. Gihon, Medical Director, U. 
S. N. The apparatus in general consists of two mains 
running the whole length of the vessel, opening into a 
blower room in which a fan revolves. The revolving 
fan causes an up-draught exhausting the air from the 
mains. From these, small pipes run to every state-room, 

* Hartshorne, H. Our Homes, p. 64. 



28 TEXT-BOOK OF HYGIENE. 

store-room, passage-way, frame-space and cul-de-sac in 
the vessel. By opening the frame-spaces* on the upper 
deck (an original device of Dr. Gihon), fresh air is 
freely supplied, bathing the whole frame or hull, and 
passing directly into the bilges, diluting the foul air, 
and thence being drawn by the aspirating force of the 
fan into the main ventilator conduits. 

[In addition to the works mentioned in the text, 
the following may be referred to as more fully treating 
of the subjects considered in this chapter : 

Flammarion: The Atmosphere. — The Articles on Atmosphere, and 
Climate in the Encyclopedia Brittanica, 9th Edition. — Reports of the 
Chief Signal Officer of the Army. — A paper on Climate and Diseases, by Dr. 
Cleveland Abbe, in Report of National Board of Health for 1880. — Die 
Canalgase, by Dr. F. Renk, Munchen, 1884.--Morin: On Warming and 
Ventilating occupied Buildings ; translated in Smithsonian Report for 1873 
and 1874] 

* Frame-spaces are the spaces between the timbers or ribs of a vessel. 



CHAPTER II. 

WATER. 

Physiologists teach that nearly two-thirds of the 
tissue of the animal body consists of water. Inasmuch 
as this water is constantly being lost by evaporation 
from the skin, exhalation by the lungs, and excretion 
through various organs, it is evident that the loss must 
be constantly supplied if the functions of life shall be 
properly performed. 

It appears probable that certain diseases are at 
times spread through the agency of insufficient or im- 
pure drinking water. It is therefore a matter of very 
great importance to have a definite notion of what con- 
stitutes a pure and sufficient supply of water, and how 
best to secure it ; to be able to detect its conditions of 
purity and impurity, and to know how to maintain the 
former, and avoid the latter. It will be necessary to 
consider in detail, therefore, the quantity of water 
required by each individual for the maintenance of 
health, the sources whence water is obtained, how it 
shall be collected and stored to the best advantage, the 
impurities likely to be contained in it, and the methods 
of keeping it pure, or of purifying it when it has become 
polluted or vitiated in any manner. 

THE QUANTITY OF WATER REQUIRED BY HUMAN BEINGS. 

Dr. Parkes, after a number of experiments, con- 
cluded that a man of the English middle class, 'who 
may be taken as a fair type of a cleanly man belonging 
to a fairly cleanly household ' uses about twelve gallons 
of water per day. This covers all the water needed, 
including a daily sponge bath. Dr. DeChaumont esti- 
mates* that sixteen gallons should be the daily allow- 

* Parkbs' Hygiene, 6th Ed., N. T., Vol. I., p. 5. 



30 TEXT-BOOK OF HYGIENE'. 

ance. By order of the British War Department, 15 
gallons of water are allowed to each soldier daily. 
In very many instances, this quantity cannot be fur- 
nished, bnt in such cases there necessarily results some 
deficiency in cleanliness. It is probable that among 
the poorer classes, especially where a large supply of 
water is not convenient, the quantity used is not over 
one-fourth of the above estimate. 

In estimating the daily supply of water needed in 
a community, large or small, other circumstances must 
be taken into consideration, in addition to the demands 
of the individual. For example, in towns or cities, 
allowances must be made for animals, manufacturing 
purposes, probable waste, fires, sewerage, etc. In cities 
an allowance of 50 gallons daily per head would not be 
excessive. In most American cities the supply is much 
greater. The present daily supply in Baltimore is esti- 
mated at 60 gallons per head,* which could be increased 
to three times that quantity if necessary. 

A serious pi'oblem. affecting, however, the engineer, 
rather than the sanitarian, is the prevention of waste 
of water in places where the supply is limited. It is 
estimated that in Chicago one-half of the water pumped 
is wasted through negligence and imperfections in the 
supply apparatus, while in St. Louis, the annual cost to 
the city of the water that is wasted is placed at 8400. 000. + 
It has been proposed to check this wanton waste by 
measuring the quantity of water used by each house- 
hold by means of a meter, as the supply of gas is now 
measured, and this has been carried into effect in 
places. There are, however, serious objections to this 
method. One of the objections is that the very class of 
persons whom it is desired to induce to use a plentiful 

* Personal communication of Mr. R. K. Maktin. Chief Engineer to the Water 
Board. 

t Buck's Hygiene and Public Health. Vol. I. p. 214. 



WATER. 31 

supply of water, would from motives of economy, use 
less than is necessary for cleanliness and health. A 
system of vigilant inspection of the water service in 
houses would probably serve to reduce this unnecessary 
waste to a considerable extent. 

SOURCES OF DRIXKING WATER. 

All water, from whatever direct source odtained, 
comes originally, by precipitation, from the atmosphere. 
In many places the rain or snow water is the only source 
of supply. This is usually collected as it falls upon 
the roofs of buildings and conveyed by gutters and 
pipes to cisterns, where it is stored until needed. 

In Venice, the rain falling upon the streets and 
court-yards is also collected in cisterns after filtering- 
through sand. The cisterns used for the storage of 
water in New Orleans and other southern cities in the 
United States, where the temperature rarely falls below 
the freezing point, are generally constructed of wood 
and placed above ground. Farther north, where it is 
necessary to protect them against the action of frost, 
they are placed underground. These underground cis- 
terns are usually built of brick. The water from cis- 
terns above ground becomes very much heated, in sum- 
mer, and necessitates the use of large quantities of ice to 
make it palatable. The water from the underground 
cisterns is pleasantly cool in summmer, and is also 
guarded against freezing in winter. There are, however, 
very serious objections to storing drinking water in 
underground cisterns. These reservoirs are usually 
placed within a few feet of privies and cess-pools, and as 
neither the retaining walls of the cisterns, nor those of 
the privies are water-tight, it often happens that the 
drinking water becomes strongly impregnated with the 
soluble portions of the excrement, or the products of its 
decomposition, which have drained into the cistern. 



32 TEXT-BOOK OF HYGIENE. 

Personal observations in Memphis in 1879, as well as 
the careful chemical analyses made afterward by Dr. 
Chas. Smart, U. S. A.,* have convinced the author that 
the objections to all underground cisterns built of brick, 
stone, or cement, are insuperable from a sanitary point 
of view. Dr. Smart found over one-half of the under- 
ground cisterns examined by him in Memphis and other 
cities and towns to be leaky and presenting evidence of 
organic pollution. The water from 31 out of 80 cisterns 
analyzed, showed decided contamination by sewage. 
It would seem advisable to prohibit all underground 
cisterns for the storage of drinking water unless they 
are constructed of iron, which should be protected 
against oxidation by a thorough coating of coal tar. 
Where any other system of collection and storage is 
available, however, the underground cistern should be 
unreservedly condemned. 

Rain water collected in the country, away from 
manufacturing districts, is usually quite pure and whole- 
some. Its taste is however flat and insipid, owing to ab- 
sence of carbonic acid gas and mineral constituents. In 
cities rain water frequently contains such a large amount 
of organic matter and other impurities, which have 
been washed out of the air by the rain, that it may be 
unfit for drinking. On account of its softness, rain 
water is, however, very desirable for washing and other 
domestic purposes. If the statement made in the last 
chapter, concerning the presence of organisms in the 
atmosphere is remembered, it will be evident on a mo- 
ment' s thought that such organisms, when contained 
in rain water may be the source of disease. The putre- 
faction which so readily takes place in rain water upon 
standing a few days is caused by certain of the organ- 
isms carried down out of the lower strata of the air by 
the descending rain or snow. 

* Report National Board of Health, 1880, p. 437-441. 



WATEE. 33 

Precipitation is an exceedingly unreliable source 
of water, and should never be depended upon when 
other sources of supply are available. Water famines 
are frequent wherever people are compelled to rely upon 
such an uncertain source of supply as rain or snow. 

Rivers and smaller streams probably supply the 
larger number of cities and towns in this country with 
drinking water. When care is taken to prevent the 
pollution of the stream above the point whence the 
water is taken, this is usually of fair quality for domes- 
tic purposes. When the river can be tapped near 
its source, or before a large number of manufacturing- 
establishments can empty their waste products into its 
current, or before it receives the sewage of a consider- 
able number of inhabitants living on its banks, the 
water can generally be regarded as safe. It is very 
difficult, however, except in the less settled portions 
of the country to find these favorable conditions present. 

Among the minor objections to the use of river 
water for domestic purposes are the liability of most 
streams to become turbid in times of freshet, and the 
discoloration of the water from dissolved coloring mat- 
ters if the stream flows through a marshy or peaty re- 
gion. These objections are, however, not serious, as 
filtration will readily remove the suspended matters. 
The coloring matter is probably harmless. The organic 
matter contained in the water of some streams, even 
when pollution by sewage and manufacturing refuse is 
absolutely excluded, may, however, be the cause of 
disease. Dr. Smart has shown* that the water from 
streams in Nebraska, Wyoming and Utah contained 
organic matter varying in amount from .16 to .28 parts 
per million, f He thinks the so-called ' mountain fever ' 

* American Journal Med- Sciences, January, 1878, p. 28 et seq. 
t The source of this organic matter seems to be the melted snow which makes 
up a large portion of the streams. 



34 TEXT-BOOK OF HYGIENE. 

of the Rocky Mountain region is a malarial fever caused 
by the large amount of organic matter in the drinking 
water. 

The most serious objection to the use of river water 
for domestic purposes, is the employment of streams as 
carriers of refuse from manufacturing establishments, 
or of the sewage of cities and towns. In Great Britain 
and some parts of the continent of Europe, owing to the 
density of population and the variety and extent of 
manufacturing industries, many of the streams are in 
an extremely filthy condition. In this country too, 
especially in the more thickly settled manufacturing 
districts of. New England, the pollution of rivers has 
increased to a degree to seriously jeopardize the health 
of the people who are compelled to draw their water 
supply from such streams. Several years since a com- 
mission was appointed by the State Board of Health 
of Massachusetts to inquire into the extent of the pol- 
lution of the streams in that State, and to devise means 
for preventing such pollution. The commission ex- 
tended its inquiries and observations over several years, 
reporting the result to the State authorities at inter- 
vals.* It was found that the water of the Blackstone 
river, at Blackstone, where it crosses the State line and 
enters Rhode Island, contained over ten per cent, of 
sewage and refuse matters, f Other streams in Massa- 
chusetts showed similar pollution. That the presence 
of such excessive amounts of refuse matters renders the 
water unsuitable for domestic purposes, must appear 
evident. It is probable, however, that the most dan- 
gerous of the polluting matters are the excreta of human 
beings, especially those of patients suffering from cer- 
tain specific diseases, such as typhoid fever, or cholera. 

* Reports State Board of Health of Massachusetts for 1873, 1874, 1876, 1877, 
1878, 1879, 1880. 

t Report State Board of Health of Massachusetts, 1876, p. 145. 



WATER. 35 

Only a few years ago it was a generally accepted 
theory that running water, though polluted by sewage, 
' purified itself after flowing a distance of twelve miles, 
and the comforting and reassuring doctrine is still held 
by many. Recent observations point to the conclusion, 
however, that the self-purification of rivers is not en- 
tirely to be relied upon. A certain proportion of the 
sewage, it is true, undergoes oxidation in the presence 
of light and air, and minute organisms,* and so becomes 
changed into other, possibly innocuous compounds. 
But at present it is not known what proportion, or 
what kind of organic matter does undergo this change. 
Another portion of the impurities is deposited upon the 
bottom and sides of the stream, having been only held 
in suspension and not dissolved in the water. A por- 
tion probably forms chemical combinations with other 
suspended or dissolved matters, and is changed into 
compounds which may be volatile and pass off into the 
air, or form insoluble precipitates. 

The remainder is rendered less perceptible, or 
imperceptible to chemical means by dilution. Every 
1 stream has sources of inflowing water — feeders — which 
increase its volume and thus dilute any foreign admix- 
ture. 

In view of these facts, the theory of the self -purifi- 
cation of streams, as formerly held, can no longer be 
regarded as true. But it is unquestionably true that 
running water does regain its purity if the inflow of 
sewage and other refuse is not excessive. It cannot be 
stated with confidence, however, when a stream, once 
polluted, becomes fit for use again. Moreover, as it is 
not possible by any practicable chemical treatment, or 
filtration, to make a polluted water absolutely whole- 
some, it is safer not to use as a source of domestic sup- 

* Mueller and Falk : Desinfection, in Eulenburg's Realencyclopaedie d. ges. 
Heilkunde, vol IV., p. 68. 



36 TEXT-BOOK OF HYGIEJSTE. • 

ply, a stream which is known to have been seriously 
contaminated by sewage matters or other impurities. 

The water from fresh- water lakes and ponds is gen- 
erally to be preferred to river water for domestic use. 
It is less liable to become turbid from time to time, and, 
except in the case of small ponds, inflow of sewage is 
not likely to cause fouling of the water to any serious 
extent. When the supply can be drawn from large 
lakes, as is done in Chicago and other cities on the 
great lakes of the United States, no purer or better 
source can be desired. In these cases the point whence 
the water is taken, should be far enough from shore to 
avoid possibility of sewage contamination. When the 
water-supply is taken from small ponds, all sewage and 
waste products from houses and factories must be rigidly 
excluded ; otherwise, diseases, attributable to the pol- 
luted water, are likely to arise among those using the 
same. 

The water in small lakes and storage reservoirs 
sometimes becomes offensive in taste and odor. The 
water-supplies of several of the large Eastern cities 
have within the past three or four years at times had a 
peculiar odor and taste somewhat resembling cucumbers. 
After considerable study, Prof. Ira Remsen, of Balti- 
more, found the cause of this odor and taste in a mi- 
nute fresh-water sponge, the spongilla fluviatilis. A 
still more offensive odor, tersely described as the 'pig- 
pen odor' is given to the water by the decay of certain 
species of nostoc and other algse. It is not known that 
either these vegetable, or animal organisms, if present, 
render the water prejudicial to health. 

Ponds are often used as sources of ice-supply. It 
was formerly supposed that in the process of freezing, 
solid matters in the water were not included in the 
block of ice when congelation occurred. Recent obser- 
vations have shown the falsity of this assumption. In 



WATER. 37 

1875, an outbreak of acute intestinal disease at Rye 
Beach, New Hampshire, led to an inquiry by Dr. A. 
H. Nichols, which disclosed the fact that the ice used 
contained a large percentage of organic matter.* The 
use of ice from a different source was followed by an 
almost immediate disappearance of the disease. Upon 
further investigation, it was discovered that the impure 
ice had been gathered from a small, stagnant pond into 
which a small brook carried large quantities of saw- 
dust from several saw-mills. The water of the pond 
was loaded with organic matter, and in summer the 
gases of decay arising from it were very offensive. 
Chemical examination showed that the ice from this 
pond contained nearly 6 parts of organic matter in 
100,000, while in pure ice the organic matter amounted 
to only .3 parts in 100,000. A similar investigation 
into the character of the ice furnished to the residents 
of Newport, R. I., was made under the auspices of the 
Sanitary Protection Association of that city. The ice, 
which was cut from ponds in the immediate neigh- 
borhood of the city, was found to contain an excessive 
proportion of organic matter. Large quantities of sew- 
age and other impurities were discharged into these 
ponds, f 

A careful series of experiments recently made by 
Dr. C. P. Pengra, of Michigan, shows:}: that the purifi- 
cation of the water by freezing is in no sense- absolute. 
In experimenting with bacteria, infusoria and other 
organisms, he found that from 9 to 11 per cent, remained 
in the ice, and retained their vitality, so that when 
thawed, they rapidly multiplied, and there was no ap- 
parent loss of numbers. In the ordinary process of 
freezing, the upper portion is the purest, but if snow 

* Report Massachusetts State Board of Health, 1876, p. 4t>7. 
t The Dangers of Impure lee. The Sanitarian, May, 1882. 

t Private communication to the author. The memoir of Dr.. Pengra will be 
published in the Report of the Michigan State Board of Health for 1884. 



dO TEXT-BOOK OF HYGIENE. 

or rain fall upon the ice, and freeze, this upper layer 
will be found much more impure than the lower. Ra- 
tional conclusions from these experiments are, that ice 
should not be gathered from an impure source, and 
that an early harvest of the ice should be encouraged. 

Springs and wells supply the water for most per- 
sons not aggregated in large communities, as cities and 
towns. Even in the latter, no inconsiderable quantity 
of the water used for drinking and domestic purposes 
is derived from wells. Spring water usually comes from 
.a source at a considerable depth below the surface, that 
is to say, the water has percolated through thick strata 
of soil, before reappearing at the surface. In its pas- 
sage through the soil it has lost most of its organic 
matter, and perhaps taken up mineral and gaseous 
constituents in larger quantities. It may be so strongly 
impregnated with the latter, as to vitiate it for ordi- 
nary use and to render it valuable as a medicine. Ordi- 
narily, however, spring water is clear, cool and spark- 
ling, with a refreshing taste and uniform temperature, 
and in all respects an agreeable and wholesome beverage. 

The character of well-water, on the contrary, is 
often justly open to grave suspicion. Being derived 
from those strata of the soil which are most likely to 
be contaminated by the products of animal and vege- 
table decomposition, the wholesomeness of the water is 
inversely proportional to the degree of saturation of the 
soil with the products of decay. It has been found by 
experiment that when organic matter largely diluted 
with water is allowed to percolate through soil, it under- 
goes a gradual decomposition in the presence of certain 
minute organisms, nitrates and' nitrites being formed at 
the expense of the ammonia and other organic combi- 
nations. If, however, the soil is saturated with organic 
matter in excess, and in a state of concentration, putre- 
faction takes place, and the conversion of the organic 



WATEE. 39 

matter into nitrates and nitrites is retarded. Hence, 
the drainage of diluted sewage through a stratum of po- 
rous soil, not already saturated with putrefying matters, 
has no especially bad significance, even if the liquid 
should reach a well used as a source of drinking water. 
It is probable that by the time the liquid portion of the 
sewage reached the well it would have arrived at that 
point when it could truthfully be termed pure water. 
At the same time it must be remembered that the puri- 
fying power of the soil cannot be relied upon if the 
supply of sewage or other animal or vegetable impurity 
is too abundant. 

Distillation is sometimes resorted to for the purpose 
of procuring drinking water, especially at sea. Vessels 
now generally carry a still for this purpose. The prin- 
cipal objection to distilled water is its insipidity, due 
to the absence of carbonic acid gas and mineral con- 
stituents, which give to good drinking water its savor. 
Distilled water may be aerated, by passing it in fine 
streams through holes in the bottom of a cask, elevated 
so as to allow the water to pass through a considerable 
stratum of air. Lead is sometimes taken up from the 
distilling apparatus, and may cause lead poisoning in 
those using the water. 

Drinking water is sometimes procured by melting 
snow or ice. It is not probable that water derived 
from these sources is unwholesome, although there is 
strong popular prejudice against it. Ice and snow may 
however contain large amounts of impurities, as already 
referred to,* and be, for this reason unfit for use. 

The following qualities are desirable in water for 
drinking and domestic purposes. 

1. The water should be colorless, transparent, suf- 
ficiently aerated, of uniform temperature throughout 
the year, and without odor or decided taste. 



40 TEXT-BOOK OF HYGIEXE. 

2. The mineral constituents (magnesium and lime 
salts) should not be present in greater proportion than 
three or four grains per gallon. More than this gives 
to water that quality known as 'hardness.' 

3. There should be but little organic matter present, 
and no living or dead animal or vegetable organisms. 

4. The water should be entirely free from ammo- 
nia and nitrous acid, and should contain but very 
small quantities of nitrates, chlorides and sulphates. 

5. It should contain less than one-twentieth of a 
grain of lead per gallon. A larger proportion is likely 
to be followed by lead poisoning. 

IMPTJEITIES IN WATEIi. 

The transparency and the color of water are 
affected by the presence of suspended or dissolved, min- 
eral or organic matters. If, after standing for a time, 
the water deposits a sediment, this is dependent upon 
insoluble matters. If the sediment turns black when 
heated in a porcelain capsule over an alcohol or gas 
flame, it contains organic matter. If the sediment or 
residue effervesces upon the addition of hydrochloric 
acid, the presence of carbonates is indicated. Water 
may be colored by metallic salts or by vegetable matter. 
It may also contain large quantities of mineral or or- 
ganic matter, or even living organisms, without percep- 
tibly diminishing its transparency. For example, the 
ova of tape-worms may exist in water in considerable 
numbers, and yet remain perfectly invisible, except 
under the microscope. 

The presence of sulphur compounds, or of various 
vegetable and animal organisms (sponges, alga?, etc.*) 
may give to water an unpleasant odor and taste. In 
the oil regions of this country most of the drinking- 
water is contaminated with petroleum, which is very 



WATER. 41 

disagreeable to one unaccustomed to it. It is not prob- 
able that the small quantities of the oil imbibed with 
the water have any deleterious influences upon the 
organism. 

Many works on hygiene fix a limit to the amount 
of solid matter allowable in drinking water. The In- 
ternational Congress of Hygiene, at Brussels, fixed the 
limit at 50 parts in 100,000. It is impossible, however, 
to say of any particular specimen of water, that its 
content of solid matter, whether organic or mineral, 
will be prejudicial to health, without trial. At the 
same time it is prudent to reject all waters containing 
a considerable proportion of solid organic matter, as 
determined by the degree of blackening or heating the 
sediment, or residue after evaporation. 

The hardness of water is due to the presence of 
earthy carbonates, or sulphates, or both. If the hard- 
ness, is due to carbonates, it is dissipated by heat, as 
in boiling the water ; the carbonic acid is driven off, 
and the base (calcium or magnesium oxide) is precipi- 
tated upon the bottom and sides of the vessel. This 
is termed the 'removable hardness.'' The hardness 
due to the presence of earthy sulphates is not removed 
upon heating the water, and is termed the 'permanent 
hardness.' The hardness depending upon both the car- 
bonates and sulphates is called the 'total hardness.' 

The proportion of the above mentioned earthy salts 
present in a given specimen of water, is determined by 
what is called the soap-test. This test depends upon 
the property which lime and magnesia salts possess of 
decomposing soap, (oleate and stearate of soda). The 
quantity of a solution of soap of a definite composition 
decomposed by a quantity of hard water, indicates the 
amount of the salts present. In this country and Eng- 
land, this is generally expressed in degrees of Clark' s 
scale, which are equivalent to grains of carbonate of 



42 TEXT-BOOK OF HYGIEXE. 

lime per imperial gallon. Thus, if the chemist says 
that a certain sample of water has a total hardness of 
16°, he means that the earthy salts in the sample decom- 
pose the same quantity of soap that would be. decom- 
posed by 16 grains of carbonate of lime per imperial 
gallon. In G-ermany each degree of the scale used ex- 
presses the soap decomposed by one part of calcium 
oxide per 100,000. In the scale used in France each 
degree corresponds to 1 part of carbonate of lime in 
100,000. So much of the hardness of water as is due 
to carbonates, can be dissipated by boiling, which 
drives off the free carbonic acid. 

Hard water is objectionable for domestic use as it 
is wasteful of soap. In cooking certain vegetables, 
such as peas and beans, the hulls are not thoroughly 
softened. In making infusions of tea and coffee, larger 
quantities of these materials are needed than where 
soft water is used. 

DISEASES DUE TO IMPURE DKIXKIKG WATER. 

Hard water is popularly believed to be the cause of 
calculous diseases, and of goitre and cretinism, but no 
reliable observations are on record showing that the 
belief is founded upon fact. At the same time it is 
undoubtedly true that calcareous waters produce 
gastric and intestinal derangements in those unaccus- 
tomed to their use. 

Large amounts of suspended mineral matter are 
frequently present in river water, and may give rise to 
derangements of the digestive organs. If there is 
carbonate of lime present, the water can be easily 
clarified by the addition of a small quantity of alum. 
Sulphate of lime and a bulky precipitate of hydrate 
of alumina are formed, which carry the suspended 
matters to the bottom. About six grains of crystallized 
alum are sufficient to clarify a gallon of water. This. 



WATER. 43 

amount of alum is too small to affect the taste of the 
water perceptibly. This method is frequently used to 
clarify and render fit for use the water of the Missis- 
sippi river, which is usually very muddy. Dr. Parkes 
quotes the following striking instance of the practical 
value of clarifying muddy water by means of alum.* 
In 1868, the right wing of the 92nd Regiment of High- 
landers, going up the river Indus, suffered from 
diarrhoea from the use of the water, which was very 
muddy. The left wing of the same regiment used 
water from the same source, but precipitated the sus- 
pended matters with alum, and had no diarrhoea. The 
right wing then adopted the same plan with like 
success. Although the opinion is wide-spread that 
water containing much mineral matter, either in solu- 
tion or in suspension, is deleterious to health, there is 
very little evidence absolutely reliable upon this point. 
The presence of large quantities of organic matter 
in water, whether these matters be of animal or vege- 
table origin, must always be looked upon with suspicion. 
The observation was made by Hippocrates twenty-three 
centuries ago, that persons using the water from 
marshes, i. e.,|*water containing 1 ^vegetable ma tter, 
suffer from enlarged spleens. §|! Many physicians, both 
of ancient and modern times seem to have held this 
opinion, but the first positive observation in medical 
literature is the now classical one of the ship Argo, 
reported by Boudin.f In 1834, the transport Argo, 
in company with two other vessels, carried 800 soldiers 
from Bona in Algiers, to Marseilles. The troops were 
all in good health when they left Algiers. All three 
of the vessels arrived in Marseilles on the same day. 
In two of them there were 680 men, not one of whom 
was sick. Out of the remaining 120 men who were 

* Manual of Hygiene. 6th Ed., N. Y., Vol. I, p. 81. 

+ Quoted in Parkes. op. eit. p. 48. Nowak : Lehrbuch der Hygiene, p. 51 ; and in 
numerous other publications on Hygiene. 



44 TEXT-BOOK OF HYGIENE. 

on the third vessel, the Argo, 13 died during the pas- 
sage, and 98 of the 107 survivors suffered from palu- 
dal fevers of all forms. None of the crew of the 
Argo were sick however. The two vessels exempt 
from sickness, and the crew of the Argo had been 
supplied with pure water, while the soldiers on the 
latter vessel had been furnished with water from a 
marsh. This water was said to have a disagreeable 
odor and taste. The testimony of a large number of 
East Indian physicians is also quoted by Parkes in 
support of the view that malarial fevers are often 
caused by impure drinking water. The observations of 
Dr. Charles Smart upon the production of the 'mount- 
ain fever' of the Westerfi territories, have already 
been referred to. The author ventures to state it as his 
opinion however, that the instances in which malarial 
fevers are due to impure drinking water are very rare. 

The causation of typhoid fever and cholera by 
impure drinking water will be presently referred to. 
Recently the opinion has been expressed by some that 
yellow fever and diphtheria are also spread by polluted 
drinking water, but no strong evidence has yet been 
adduced in its support. 

There can be very little doubt that diarrhoea and 
dysentery are frequently caused by water which has 
been contaminated with decaying organic matter. The 
evidence in favor of this amounts practically to demon- 
stration. 

It must not be forgotten that the ova of certain 
animal parasites, as distoma hematobiiim, filaria san- 
guinis hominis, and medinensis, anchylostoma duode- 
nale, and possibly of round and tape worms, are taken 
into the system with the drinking water. 

Organic detritus of various kinds, sewage, decom- 
posing animal and vegetable matter, refuse from 
manufacturing establishments, may be a source of pol- 



WATER. 45 

hition of water and render it unfit for drinking or other 
domestic purposes. It is, however, not certain that 
water thus rendered unclean is prejudicial to health ; 
in fact Dr. Emmerich, of Munich has recently put his 
skepticism on this point to a practical test. For two 
weeks he drank daily from one to two pints of very 
filthy water; in fact, nothing less than sewage. The 
water was both chemically and physically exceedingly 
impure. Several of the experimenter's patients par- 
took of the same water without any ill effect. He even 
claims that a gastric catarrh from which he was suffer- 
ing when the experiment was begun, improved during 
its course.* 

The results of Emmerich's experiments, and of 
other well-known observations seem almost conclusive 
that the products of animal and vegetable decomposi- 
tion, taken into the body with the drinking water, can 
not be looked upon as certainly harmful. Should, 
however, water containing such impurities, or even 
water apparently pure, contain the germs of one of the 
specific diseases: cholera, typhoid fever, or perhaps 
yellow, malarial or scarlet fevers, or diphtheria, it is 
probable that such disease would be communicated to 
the consumer of the water. 

Many instances are on record where outbreaks of 
typhoid fever have been clearly attributable to pollu- 
tion of the drinking water by the germ of the disease 
from a previous case. 

One of the most remarkable of these outbreaks is 
that recorded by Dr. Thorne.f About the end of 
January, 1879, typhoid fever began suddenly in the 
adjoining towns of Caterham and Red Hill. Within 
six weeks three hundred and fifty-two cases occurred. 

* Wolffhtjegel : Wasserversorgung, in Pettenkofek u. Ziemssen's Handtrach 
der Hygiene. I. Abth., II. Hlfte., p. 97. 

t Report of the Medical Officer to the Local Government Board for 1879. Quoted 
in Fodor: Hygienische TJntersuchungen, etc., II, Abth. p. 261. 



46 TEXT-BOOK OF HYGIENE. 

All other sources of the disease were excluded, except 
the drinking water, to pollution of which it was traced 
with almost absolute certainty. Caterham contained 
558 houses and Red Hill 1700. Of the former, 419 and 
of the latter 924 draw their drinking water from a 
common supply, having its source in a well several 
hundred feet deep. The insane asylum with 2000 in- 
mates, and the military barracks in Caterham used 
water from a private well. There was no typhoid fever 
among the last two communities. During January one 
of the workmen engaged in some excavation near the 
public well was taken ill with diarrhoea and fever — 
probably typhoid, but was still able to continue his work. 
His dejections were often voided where they were certain 
to become mingled with the water of the common sup- 
ply. This man's diarrhoea began on January 5th, and 
continued until the 20th of the month, during which 
time he remained at work. On the latter date, he was 
compelled to quit work and take to his bed. Exactly 
two weeks from the beginning of the man' s sickness, on 
January 19th, the first case of typhoid occurred in Ca- 
terham, and then rapidly increased. The first case 
occurred, therefore, just fourteen days — the incubative 
period of typhoid — after the presumed infection of the 
the drinking water by the dejections of the sick laborer, 
who had come from Croydon, where typhoid fever was 
at the time prevalent. Within two weeks from the 
appearance of the first case, the epidemic had reached 
its height, and then rapidly declined, disappearing 
almost entirely in a month after the outbreak. It was 
shown by Dr. Thorne that nearly all the houses in which 
the disease appeared were supplied with water from the 
source above mentioned, while other houses in the im- 
mediate vicinity of the infected ones remained free 
from the disease. 



WATER. 47 

In 1874 there was an outbreak of typhoid fever in 
the town of Over Darwen, in which nearly 10 per cent, 
of the inhabitants were attacked. Here the source of 
the disease was also traced to an infected water supply. 

Dr. Buchanan has shown that an outbreak among 
the students of the University of Cambridge, was like- 
wise attributable to an infected water supply. 

In this country the reports of the Boards of Health 
of the various States teem with accounts of localized 
outbreaks of typhoid fever referred to infected or pol- 
luted drinking water. In most instances the evidence 
furnished by the observers is not conclusive. In many, 
however, especially of those found in the Massachusetts 
and Michigan reports the fact of the communication 
of the disease in this manner seems unquestionable. 
One of these is as follows : Out of forty families, all 
using water from a certain well, there occurred 23 cases 
of typhoid fever. Out of forty-seven families living 
in the same neighborhood, but using water from differ- 
ent sources, only two had typhoid fever.* Dr. C. F. Fol- 
som has published a very suggestive account of a house 
epidemic,! where nine cases in a single house, who all 
drank water from a well which was proven to be in- 
fected from a privy, were attacked by this disease. 

The numerous cases of typhoid fever, which have 
been attributed to the use of infected milk may be in- 
cluded in this category. It is probable that the milk 
became infected either through polluted water used for 
the purpose of cleansing the milk vessels, or in diluting 
the milk. Mr. Ernest Hart has recorded:}: fifty epidem- 
ics of typhoid fever, fifteen of scarlet fever, and seven 
of diphtheria, the cause of which he has attributed to 
infected milk. 

* Transactions Mich. Med. Society, 1883, p. 401. 

t Boston Med. and Surg. Journal, vol. CIL, p. 227, 261. 

$ Transactions Int. Med. Congress, 1881, vol. IV. p. 391. 



48 TEXT-BOOK OF HYGIEJSTE. 

It is not probable, however, that typhoid fever is 
always, or in the majority of cases spread through the 
medium of polluted drinking water, but in many of the 
instances on record, the relations between cause and 
and effect, — impure water and typhoid fever, have 
been so clearly made out as to no longer permit any 
doubt upon the question. 

As it is with typhoid fever, so also with cholera. 
In a later chapter the origin and propagation of ty- 
phoid fever and cholera will be discussed more fully. 
At the present time only the relations of the drinking 
water to the spread of these diseases can be consid- 
ered. In the instance to be presently noted, the con- 
nexion between the infected water on the one hand and 
the outbreak of cholera on the other is so clearly shown 
as to be almost equivalent to a mathematical demon- 
stration, The facts in the case, were brought to light 
after a patient inquiry by a commission whose report 
drawn up by Mr. John Marshall, has made the occur- 
rence classical. In 1854, the people of a well-to-do, 
and otherwise healthy district in the Eastern part of 
London suffered severely from cholera. Upon inquiry 
the fact was elicited that a child had died of cholera 
at No. 40 Broad street, and that its excreta had been emp- 
tied into a cess-pool situated only three feet from the 
well of a public pump in that street, from which most of 
the neighboring people took their drinking water. It 
was further discovered that the bricks of the cess-pool 
wall were loose and permitted its contents to drain into 
the pump-well. (It should be noted that the commu- 
nication between the cess-pool and well was direct ; that 
there was immediate drainage, not percolation through 
the soil). In one day 140 to 150 people were attacked 
and it was found that nearly all the persons who had 
the malady during the first few days of the outbreak 
drank the water from the pump. "When the pump 



WATER. 49 

was closed to public use by the authorities, the epidemic 
subsided. The most singular case connected with this 
outbreak was the following: In West End, Hamp- 
stead, several miles away from Broad street, there oc- 
curred a fatal case of cholera, in a woman, 59 years 
old. This woman formerly lived in Broad street, but 
had not been there for many months. A cart, how- 
ever, went daily from Broad street to West End, carry- 
ing among other things, a large bottle of water from 
the pump referred to. The old lady preferred this 
water to all others, and secured a daily supply in the 
manner stated. A niece who was on a visit to the old 
lady drank of the same water. She returned to her 
home, in a high and healthy part of Islington, was 
likewise attacked by cholera and died. There were, at 
this time, no other cases of cholera at West End, or 
in the neighborhood of these last two persons attacked. 

Most of the English medical officers in India hold 
strongly to the view that cholera is spread by polluted 
drinking water, and the evidence in its favor is very 
strong. 

The evidence in favor of the influence of impure 
drinking water on the causation of other diseases than 
those mentioned is not sufficient to justify any conclu- 
sions at present. 

The source of a water-supply may be pure, and 
yet pollution may occur before the water is used by the 
persons to whom it is distributed. Supply pipes may 
become defective and the water become contaminated 
with sewage or other deleterious substances. It is a 
current belief that no impurity can gain access to hy- 
drant pipes between the reservoir, or source of supply, 
and the point of discharge of the water. Neverthe- 
less, such contamination may occur very readily. The 
author and his colleague, Dr. J. W. Chambers, of Bal- 
timore, proved this conclusively a few years ago, by 



50 TEXT-BOOK OF HYGIENE. 

establishing an undoubted connexion between a house- 
epidemic of typhoid fever and a defect in the hydrant 
supplying the family with water.* The hydrant was 
one of the class known as Clark's patent non-freezing 
hydrant. The mechanism of these hydrants is as fol- 
lows : At the lower end of the vertical discharge pipe 
is a glazed earthenware plunger, which works through 
a ring of rubber packing into a vacuum chamber. At 
the bottom of the vacuum chamber is a valve regula- 
ting the entrance of the water from the conducting 
pipe. When the water is shut off, this valve is kept 
closed by a spiral spring. When the crank of the 
hydrant is turned forward, that is, when the water is 
'turned on,' the plunger is forced to the bottom of the 
vacuum chamber, presses on the spring, opens the valve 
and allows the water to discharge. When the crank is 
turned back, the plunger is raised, releases the spiral 
spring, which forces the valve into its bed, and shuts 
off the water. The partial vacuum produced by the 
raising of the plunger, draws the water which is in the 
vertical discharge pipe into the vacuum chamber, 
which is so far below the surface as to be unaffected by 
frost. In course of time, and with use, the rubber 
packing gets worn and permits gradual leakage into 
the vacuum chamber, of the dirty, stagnant water by 
which this part of the hydrant is always surrounded. 
Outbreaks of typhoid fever having a similar origin, in 
which the connexion between cause and effect Avas 
clearly shown have been reported by other physicians 
of the same city, f 

Aside from the practical question of the causation 
of disease by polluted water, a more abstract and aes- 
thetic idea is involved in consciously taking any impu- 

* On Preventable Pollution of Hydrant Water and its Relation to the Spread of 
Typhoid Fever. Maryland Med. Journal, Vol. VIL, p. 271. 

t Local Causes of Insanitation in Baltimore, By Johx Morbis, M. D. . Report 
Md. State Board of Health, 1S78. 



WATER. 51 

rity into the system. The instincts of man as well as 
of most animals revolt at it. These inborn instincts 
which constitute the sanitary conscience, as Soyka 
says, demand purity of food and water, as they insist 
on cleanliness of the body, of clothing, and of the 
dwelling. 

STORAGE AND PURIFICATION OF WATER. 

Wherever a large supply of water is needed, un- 
less drawn direct from a well or spring, or pumped di- 
rectly from its source, arrangements for storage are 
necessary. Cisterns and large reservoirs are made use 
of for this purpose. River water, especially, requires a 
period of rest in a storage reservoir in order to allow 
deposition of the large amount of suspended matter in 
it. Prolonged storage also gives opportunity for the 
conversion of possibly deleterious organic compounds 
into simple, and perhaps harmless, compounds. Usual- 
ly in an elaborate system of water-works, a series of 
reservoirs is built in which the water is stored succes- 
sively, so that before its final distribution through the 
street mains, it has become quite clear and pure. 
Filtration on a large scale is also used in connexion 
with storage reservoirs, in order to secure greater puri- 
ty of the water. 

In the distribution of water, care should be taken 
that nothing deleterious is taken up by the water in 
its passage through the pipes. Lead poisoning is not 
infrequent from drinking water that has passed through 
a long reach of lead pipe, or which has been standing in 
a vessel lined with lead. Tanks and storage cisterns 
should therefore not be lined with lead, and the use of 
lead pipe in the supply- service should be avoided as 
much as possible. Fortunately most natural waters pos- 
sess a considerable proportion of carbonic acid, which 
forms with the lead an almost insoluble carbonate of 



52 TEXT-BOOK OF HYGIEWE. 

lead. This carbonate of lead is deposited on the in- 
side of the pipes, and protects both the pipes against 
erosive action from other constituents of the water, 
and also prevents the contamination of the water by the 
lead. An excess of carbonic acid in the water renders 
this deposit soluble, and may cause serious poisoning. 
Any water which is shown by analysis to contain over 
one-twentieth of a grain of lead per gallon is danger- 
ous and should be rejected. 

Owing to the possibility of defilement of the water 
from improper construction of hydrants, all out-door 
hydrants should be discouraged as much as possible, 
and should be replaced by a simple tap-cock indoors. 
The pipes should also be laid deep enough under-ground, 
or otherwise protected against freezing in winter. 

A number of methods, all more or less efficient, 
have been introduced to purify water, when it needs 
purification before being fit for use. These "methods 
either comprise filtration, or seek to purify the water 
without the aid of this process. One of the methods 
of purification without filtration, consists in exposing 
the water to the air in small streams. This was pro- 
posed by Lind more than a century ago, and has since 
been frequently revived. The water is passed through a 
sieve, or a perforated tin or wooden plate, so as to cause 
it to fall for a distance through the air in finely divided 
currents. By this process sulphuretted hydrogen, offen- 
sive organic vapors, and possibly dissolved organic 
matters are removed. This process has been used in 
Russia on a large scale. 

By boiling and agitation, carbonate of lime, sul- 
phuretted hydrogen and organic matter are removed. 
or rendered innocuous. Vegetable germs are usually 
destroyed, although Tyndall has shown that some bac- 
terial germs withstand a temperature higher than that 
of boiling water. 



WATEK. 53 

As lias already been mentioned,* alum is one of the 
readiest and most efficient means of removing suspen- 
ded matters from water. 

Permanganate of potassium is sometimes used 
to purify water containing considerable organic matter. 
The permanganate rapidly oxidises the organic mat- 
ter and is believed to render it harmless. There is no 
certainty, however, that the germs of specific diseases 
are destroyed by the action of this salt, in the propor- 
tion in which it could be used for the purposes of 
water purification. 

A yellow tint is given to the water by the perman- 
ganate, which is due to finely divided peroxide of man- 
ganese. This does no harm, but is unpleasant. 

Water, unfitted for use by organic matter, is some- 
times rendered usable by infusing certain vegetable 
astringents in it. Thus, it is said that the Chinese 
drink water only in the form of tea, in certain parts of 
China, where the water contains large quantities of 
organic matter. The tannin of the tea-leaves precipi- 
tates the suspended matters and renders the water fit 
for use. Mixing the water with red wine, which is as- 
tringent, has the same effect, f 

Filtration is an efficient means of removing sus- 
pended matters. Charcoal, sand, gravel and spongy 
iron are used as filtering material. The most economical 
filter is one made of fine, clean sand, above which lay- 
ers of gravel of a gradually increasing size are placed. 
The coarser particles of suspended matter are arrested 
before the sand, which removes most of the coloring 
and organic matters, is reached. 

TESTS FOR IMPURITIES IN WATER. 

Accurate and reliable quantitative analyses of water 
can only be made by chemists of experience. Every 

* See page 42. 

t Champouillon, quoted in Med. and Surg. Hist, of the War, pt. II., Med. Volume, 



54 TEXT-BOOK OF HYGIENE. ' 

intelligent person should however know how to deter- 
mine the presence or absence of suspected impurities. 
The following methods are simple and easily carried 
out: 

To determine the presence of chlorine, or chlorides, 
(often indicating sewage contamination), acidulate 
about half an ounce of the water to be tested with pure 
nitric acid, and add a few drops of a solution of nitrate 
of silver, (24 grains to one ounce of distilled water). 
A white precipitate, gradually changing to gray, is 
produced if chlorides are present. The degree of cloud- 
iness produced will indicate approximately, the amount 
of chlorides. 'One grain of chlorine per gallon gives 
a haze ; four grains per gallon give a marked turbidity ; 
ten grains, a considerable precipitate/* If the chlo- 
rine is found by this test to exceed one grain per gal- 
lon, the source of the contamination should be searched 
for. If drainage from a cess-pool is suspected, a quan- 
tity of salt water may be thrown into it, and the water 
again tested after an interval of four hours to see 
whether the chlorine has increased. 

The presence of nitric acid, or nitrates, even in 
very minute quantities, is shown by the following test : 
A small quantity of the water is evaporated to dry- 
ness, and a few drops of a solution of carbolic acid in 
four parts of concentrated sulphuric acid and two parts 
of distilled water, added to the residue. If nitric acid is 
present, a brownish red color results, which turns green 
and then yellow upon the addition of ammonia. 

Nitrous acid or nitrites will give a reaction with 
iodide of potassium and starch. Twelve to twenty 
ounces of water in a flask are acidulated with a few 
drops of dilute sulphuric acid, and a little solution of 
iodide of potassium added. About half a dram of fresh- 
ly prepared starch is added and the mixture shaken. 

* Parkes, 1. c, p. 77. 



WATER. 55 

If nitrous acid is present, the iodide is decomposed 
setting free the iodine, which combines with the starch, 
causing a blue color. The test is a very delicate one. 

The following test will indicate the presence of am- 
monia. Make a solution of one part of bichloride of 
mercury in thirty parts of water, and another of one part 
of carbonate of potash in fifty parts of water. Five 
drops of each of these solutions are added to about 24 
ounces of the water to be tested, in a tall glass. If 
ammonia is present, a white cloudiness will appear in 
the water. If, after an interval of several hours, no 
turbidity has developed, no ammonia is present. 

To determine the presence of sulphuric acid, or 
sulphates, the water is acidulated with hydrochloric acid, 
and a solution of chloride of barium added, which gives a 
white precipitate of sulphate of barium if sulph uric acid 
is present. 

Organic matter is indicated by its reaction with 
chloride of gold, or potassium permanganate. A solu- 
tion of permanganate added to water containing organic 
matter becomes almost instantly decolorized. The ad- 
dition of chloride of gold, and boiling the water pro- 
duces first a pink color, gradually changing through 
violet to black. The water should be first slightly acid- 
ulated. 

Neither of these tests for organic matter is abso- 
lutely reliable, as nitrous acid, sulphuretted hydrogen, 
and ferrous salts produce similar reactions. 

SIGNIFICATION OF THE VARIOUS IMPURITIES INDICATED 
BY THE ABOVE TESTS. 

The following summary gives, in a brief compass, 
the inferences that may be drawn from the result of the 
above tests :■* 

* Pabkes' Hygiene, vol. I, p. 79i 



56 TEXT-BOOK OF HYGIENE. 

'If chlorine be present in considerable quantity, 
it either comes from strata containing chloride of so- 
dium or calcium, from impregnation of sea-water, or 
from admixture of liquid excreta of men and animals. 
In the first case the water is often alkaline from 
sodium carbonate; there is an absence, or nearly so, 
of oxidized organic matters, as indicated by nitric and 
nitrous acids and ammonia, and of organic matter; 
there is often much sulphuric acid. If it be from cal- 
cium chloride, there is a large precipitate with ammo- 
nium oxalate after boiling. If the chlorine be from 
impregnation with sea- water, it is often in very large 
quantity ; there is much magnesia, and little evidence 
of oxidized products from organic matters. If from 
sewage, the chlorine is marked, and there -is coinci- 
dent evidence of nitric and nitrous acids and ammonia, 
and if the contamination be recent, of oxidisable or- 
ganic matters. 

'Ammonia is almost always present in very small 
quantity, bxit if it be in large enough amount to be de- 
tected without distillation it is suspicious. If nitrates, 
etc., be also present, it is likely to be from animal sub- 
stances, excreta, etc. Nitrates and nitrites indicate 
previously existing organic matters, probably animal, 
but nitrates may also arise from vegetable matter, 
although this is probably less usual. If nitrites largely 
exist, it is generally supposed that the contamination 
is recent ; the coincidence of easily oxidized organic 
matters, of ammonia, and of chlorine in some quantity, 
would be in favor of an animal origin. If a water 
gives the test of nitric acid, but not of nitrous acid, 
and very little ammonia, either potassium, sodium or 
calcium nitrate is present, derived from soil impreg- 
nated with animal substances at some anterior date. 
If nitrites are present at first, and after a few days dis- 
appear, this arises from continued oxidation into ni- 



WATER. 57 

trates ; if nitrates disappear, it seems probable this is 
caused by the action of bacteria, or other low forms of 
life. Sometimes in such a case nitrites may be formed 
from the nitrates. Lime in large quantity indicates 
calcium carbonate if boiling removes the lime, sulphate 
or chloride or nitrate if boiling has little effect. Test- 
ing for calcium carbonate is important in connexion 
with purification with alum.* Sulphuric acid in large 
quantity with little lime, indicate sulphate of sodium, 
and usually much chloride and carbonate of sodium are 
also present, and on evaporation the water is alkaline. 
Large evidence of nitric acid, with little evidence of 
organic matter, indicates old contamination; if the 
organic matter be large, and especially if there be 
nitrous acid as well as nitric present, the impregna- 
tion is recent.' 

[The following works are recommended to those 
desiring fuller information upon the subjects embraced 
in the foregoing chapter: 

Water Supply, by Wm. Ripley Nichols, N. Y., 1884. A Guide to 
the Microscopic Examination of Drinking Water, by J. D. Macdonald, R. 
N. F. R. S. Some of the Organic Impurities found in Drinking Water, by C. 
W. Chambeblain, M. D., Rep't Ct. State Board of Health, 1880, p. 260. Mi- 
croscopical Examination of Potable Water, by W. J. Lewis, M. D.,Ibid., p- 
216.] 

* See page 42. 



CHAPTER III. 

FOOD. 

Ik order to preserve health and vigor, it is neces- 
sary for animal beings to consume at intervals a suffi- 
cient quantity of substances known as foods. Alimen- 
tary substances, or foods, may therefore be briefly 
defined as materials, which, taken into the body and 
assimilated, sustain the processes of life, promote 
growth, or prevent destruction of the organized con- 
stituents of the body. 

QUALITY AND CHARACTER OF FOOD NECESSARY. 

It has long been known, as the result of the em- 
pirical observation of feeding large bodies of people, 
that the various proximate principles must be combined 
in certain definite proportions in the food in order to 
preserve the normal degree of health and vigor of the 
body. Within a comparatively recent period, physiol- 
ogists have made experiments upon animals and human 
beings, which have led to the same conclusions, and 
have enabled these proportions to be fixed with more 
or less exactness. 

Considering man as an omnivorous animal, it may 
be laid down as an invariable rule, that the following 
four alimentary principles are necessary to his exist- 
ence.* Neither of these principles can be dispensed 
with for a prolonged period without illness or death 
resulting. 

1 . Water . — This must be supplied in sufficient quan- 
tity to permit the interchange of tissue to be carried 
on in the body. 

* Landois, Physiologie, ate Aufl. p. 448. 



FOOD. 59 

2. Salts. — Inorganic compounds of various kinds 
are necessary to the preservation and proper construc- 
tion of the tissues. They are all found in sufficient 
quantities in the various alimentary substances con- 
sumed by man and the lower animals. A deficiency of 
inorganic constituents in the food is followed by dis- 
ease. 

3. Proteids. — Organic nitrogenous material, either 
animal or vegetable, is a necessary constituent of the 
food of man. Continued existence is impossible with- 
out a sufficient supply of nitrogenous substances. 

4. Fats, or Carbo-hydrates. — The organic non-nitro- 
genous, or carbonaceous principles of food are also nec- 
essary to the continuance of health. They are sup- 
plied either by fats, or by carbo-hydrates, (sugar, starch, 
etc.,) which may be used as substitutes for each other. 
Voit has shown that seventeen parts by weight, of 
starch, is equivalent as carbonaceous or oxidisable food 
to ten parts of fat. 

According to Moleschott, the standard diet for a 
man of average height and weight, doing moderate 
work, should be as follows: Proteids, 130 grams 
(4.59 oz.); fats, 84 grams (2.96 oz.); carbo-hydrates, 404 
grams (14. 26 oz.). The proportion of nitrogenous to 
non-nitrogenous food-stuffs would therefore be 1:31, or 
speaking roughly, 1:4. When very hard work is re- 
quired, as from a prize-fighter in training, the pro- 
teids are about doubled, the fats increased by about 
one-fourth, and the carbo-hydrates decreased by two- 
thirds. 

In addition to maintaining a proper proportion be- 
tween the various alimentary principles, it is necessary 
to vary the articles of food themselves, otherwise they 
are liable to prove nauseating. The necessity of variety 
in the food, in order to preserve the appetite, is famil- 
iar to everyone. 



60 TEXT-BOOK OF HYGIENE. 

The table here given, * shows the relative propor- 
tions of nitrogenous to non-nitrogenous alimentary 
principles in the various substances named : 

NITROGENOUS. NON-NITEOGENOT7S. 

Veal, 

Beef, 

Lentils, .... 



10. 


1. 


10. 


17. 


10. 


21. 


10. 


22. 


10. 


23. 


10. 


27. 


10. 


30. 


10. 


30. 


10. 


37. 


10. 


46. 


10. 


50. 


10. 


86. 


10. 


123. 


10. 


130. 



Peas, 

Fat Mutton, .... 

Pork, 

Cow's Milk, .... 

Human Milk, - - - 

Wheat Flour, .... 
Oat Meal, ..... 
Potatoes, .... 

Rice, ..... 

Buckwheat Flour, .... 

By keeping these proportions in view it will be seen, 
at once that if a man wished to live on beef alone, he 
would have to eat four and a quarter pounds per day, 
in order to get a sufficient amount of non-nitrogenous 
food. Of potatoes, in order to get enough nitrogenous 
food he would have to eat daily eighteen pounds. Xo 
human stomach could prove equal to the task of digest- 
ing this excess of material. On the other hand, it is 
to be noted how perfect the combination of the various 
principles is in human milk. In cow's milk, which is 
nearest in composition to human milk, the non-nitro- 
genous principles are deficient. Hence, the important 
practical point that when ordering milk diet for a pa- 
tient a small portion of carbonaceous food, (bread) 
must be added, if the standard of health shall be 
reached, or maintained. 

Climate has probably very little influence upon the 
amount of food required by the individual. The 
actual quantity of food consumed varies little between 
various races, or in different parts of the earth. It is 
true, however, that a larger proportion of fat is re- 
quired in cold climates. That fatty articles of food 

* Landois, op. cit., p. 449. 



FOOD. 61 

readily undergo oxidation and furnish a large amount 
of animal heat is proven both by observation and ex- 
periment. 

The albuminoid proximate principles of the food, 
proteids, are represented by the nitrogenous constitu- 
ents of organic tissues. These are the vitellin and 
albumen of eggs, albumin, fibrin, globulin, myosin, 
syntonin and other nitrogenized principles of flesh and 
blood ; the casein of milk, the gluten, fibrin and legu- 
min of cereal and leguminous seeds and plants, gelatin 
and chondrin. 

Fat constitutes an integral component of animal 

tissue, and is found in abundance as a constituent of 

•nerve tissue, marrow, and sub-cutaneous connective 

tissue. In food it is represented especially, in the 

fatty tissue of meat, the yelk of eggs, butter, etc. 

The carbo-hydrates are represented especially by 
various products of the vegetable world, as sugar, 
starch, dextrin, etc. 

Water and the various other inorganic proximate 
principles, chief among which are compounds of cal- 
cium, sodium and potassium, are usually found in 
sufficient proportion in the other alimentary sub- 
stances. 

The food should be taken in appropriate quantities 
and properly prepared, A larger quantity than neces- 
sary may overtax the digestive organs and thus yield 
less than the required amount of nutritive material to 
the body. 

Physical exertion increases the consumption of 
albuminoid and fatty principles. Hence, as in the 
cases of the athlete or prize-fighter in training, larger 
quantities of these principles are required to keep the 
nutrition of the body at the standard of health. Du- 
ring mental work, however, less nitrogenous material 
is consumed than during physical labor. 



62 TEXT-BOOK OF HYGIENE. 

In youth the processes of combustion (production of 
carbonic acid) go on with greater rapidity than after 
adult life is reached. For this reason young persons 
rarely get fat, the fat-producing food being burnt up 
in the body by the greater metabolic activity of the 
young cell. Hence, fats and carbo-hydrates should form 
a larger relative proportion in the diet of the young, 
than in that of grown persons. 

Low external temperature causes a greater and 
more rapid consumption of fat than high external tem- 
perature. During febrile conditions, however, the de- 
struction of the stored-up fat in the body — the wasting 
away — is one of the most notable phenomena. Hence, 
the importance of supplying fat and fat-r>roducin<* 
food in chronic febrile diseases. 

'Der Mensch ist was er isst,' said Ludwig Feuer- 
bach.* The pungency of the epigram is somewhat lost 
in the translation, which is literally : ' Man is what 
he eats.' The intimate relations of mental, moral and 
physical conditions of health to the quality and quan- 
tity of food deserve the earnest attention of the edu- 
cated physician and sanitarian. 



Foods or victuals are generally divided into foods 
proper, and so-called accessary aliment. The classi- 
fication is not exact however, as the latter, which are 
commonly regarded as articles of luxury, may under 
certain circumstances become necessities, and hence 
should not be considered as forming a separate class. 

Foods are either of animal or vegetable origin. 
Those derived from animal sources are milk, the flesh 
of animals, birds, reptiles and fish, and the eggs of the 
three last-named. 

* Gottheit, Freiheit und Unsterblichkeit von Standpunkt der Anthropologic 
p. 5. 



FOOD. 63 

The foods derived from the vegetable kingdom 
comprise the seeds of various plants (cereals, legumes) 
roots, herbs, ripe fruits, the fleshy envelopes of various 
seeds (which may properly be classed with the fruits), 
and various fungi. 

There are also in common use a number of bever- 
ages, e. g., water, alcoholic liquors, alkaloidal infu- 
sions (tea, coffee, cocoa), etc. 

In addition, a number of substances or compounds 
are in common use as condiments. Their function is 
either to render victuals more palatable, or to promote 
digestion and assimilation. Vinegar, mustard, and 
common salt,*are familiar examples. 

FOODS OF ANIMAL ORIGIN. 

Millc. — Human milk is, so far as known, the one 
perfect food for man found in nature. It contains, in 
proper proportion, representatives of all the different 
classes of proximate principles necessary to nutrition. 
One hundred parts contain about 3.5 parts of proteids 
(casein and albumin); 4 parts of fat (butter); and 5 
parts of sugar. The reaction of human milk is slightly 
alkaline; that of fresh cow's milk is neutral. 

In human milk there are 12.21 parts of solid mat- 
ter to 87.79 of water, while in cow's milk the propor- 
tions are, solids 11, water 89 parts. 

Of the solids in milk, cow's milk contains more 
proteids, while human milk is richer in fats and sugar. 
Hence, in using cow's milk as a substitute for human 
milk, the proteids are diluted by the addition of water, 
and the non-nitrogenous components increased by ad- 
ding sugar, and under some circumstances, fat (cream). 

On standing, the fatty constituent of milk, the 
cream, separates, and on account of its less specific 
gravity, rises to the surface, where it forms a layer of 
varying thickness. 



64 TEXT-BOOK OF HYGIENE. 

After standing a longer interval, the milk under- 
goes certain physical and chemical changes. Lactic 
acid is formed at the expense of part of the sugar of 
milk (a sort of fermentation taking place), and acting 
upon the casein, produces coagulation. This is the so- 
called 'bonny-clabber.' When the fermentation con- 
tinues, especially under a slightly elevated tempera- 
ture, the solid portion becomes condensed (curd), and a 
sweetish- acid, amber colored liquid, the whey, sepa- 
rates. The curd, after further fermentation, under 
appropriate treatment, becomes converted into cheese. 
Whey is sometimes used alone, or mixed with wine, 
as an article of diet for the sick. 

Butter is made from the cream by prolonged agita- 
tion in a churn. The fat-globules adhere to each other 
and form a soft, unctuous mass, of a yellowish color, 
solid at ordinary temperatures. After the butter is all 
removed in this way the balance of the cream remains 
in the churn as buttermilk. This is an article of con- 
siderable nutritive value, although its excess of acid 
renders it unsuitable as an article of diet in many 
cases. 

The specific gravity of fresh milk should not be 
below 1030. It should, however, be borne in mind that 
the richest milk is not always that which has the 
highest specific gravity. In fact, a sample of rich 
milk, containing a large proportion of cream, may 
show, when tested with the lactometer, a lower specific 
gravity than a specimen of much poorer milk. Hence, 
the lactometer, although a useful instrument in guard- 
ing against excessive dilution of the milk with water, 
is not a very reliable guide in determining the quality 
of the milk. 

Objections are often urged against the use of so- 
called 'skim-milk,' i. e., milk from which the cream 
has been removed. In some cities in this country, the 



FOOD. 65 

police, or representatives of the sanitary authorities, 
seize and confiscate all skim-milk found in possession 
of dealers. There appears to be no rational basis for 
the opinion held by many that skim-milk is not a proper 
and useful article of food. Before the lactic acid fer- 
mention has taken place, it differs from fresh milk 
merely in the fatty and other matters removed in the 
cream. It may be used as an article of food with great 
advantage and entire safety. In certain diseased states, 
it is of exceptional value, as an article of diet. The 
sole objection of any weight to skim-milk is that ft may 
be at times sold fraudulently as fresh milk. This is, 
however, a question of little sanitary interest, but one 
principally of ethics. 

Milk is frequently adulterated by the addition of 
water, chalk and water, or other more deleterious sub- 
stances. An excess of water gives the milk a bluish 
tinge, and reduces its specific gravity. The addition 
of water may become especially dangerous by intro- 
ducing the virus of some of the acute infectious dis- 
eases. Thus, localized epidemics of typhoid and scarlet 
fevers, have in a number of instances been traced to 
mixing the milk with water containing the poison of 
these diseases. 

It is a mooted question whether acute or chronic 
infectious diseases of the milk-giving animal may be 
communicated to persons using the milk of such ani- 
mals. Facts at present known seem to negative the 
proposition. At the same time it would seem to be 
prudent to avoid the use of milk from diseased ani- 
mals, if possible, or to destroy any organic virus the 
milk may contain by previously boiling the milk. After 
thorough boiling little fear need be entertained of com- 
municating either acute or chronic infectious diseases 
through this medium. 



66 TEXT-BOOK OF HYGIENE. 

The milk of cows fed upon the refuse of breweries 
and distilleries, — 'swill milk,' is believed by many- 
physicians to be unwholesome. If so, it is probably 
only by reason of the unfavorable hygienic conditions 
under which the animals are kept. If the stables are 
clean, dry and well ventilated, and the animals re- 
ceive plenty of fresh air and exercise, swill-fed cows 
should produce as nutritious milk as when they are fed 
upon different food. Much of the present agitation 
against 'swill milk' is more prompted by political 
demagoguery than by scientific knowledge. 

In order to prevent the rapid fermentation of milk 
various methods of preservation have been adopted. 
The addition of alkalies, or antiseptics retards the lac- 
tic acid fermentation, while the abstraction of a por- 
tion of the water and addition of sugar (condensed 
milk) preserves it for an indefinite time. The mere ad- 
dition of water restores it to nearly its original condition. 

Butter. — Butter is of especial value as food on 
account of the large amount of easily digestible fat 
which it contains. It is almost always used as acces- 
sary to other articles of food, to render them more pal- 
atable. When pure and fresh, it is one of the most 
delicious of creature comforts. It soon undergoes the 
butyric acid fermentation, however, becoming 'ran- 
cid,' as it is termed, when it is unfit for food. 

The great demand for butter and its consequent 
high price, have led to its extensive sophistication. 
Butter is now very largely substituted by an artificial 
product termed oleo-margarine or butterine. This ar- 
tificial butter is made from beef-suet by the following 
process : Fresh beef fat is melted at as low a tempera- 
ture as possible, never higher than 126°-128° F. All 
membrane and tissue are then removed, and the result- 
ing clear fat is put into presses, where the stearine is 
extracted. The liquid fat, free from tissue, and with 



FOOD. 67 

nearly all its stearine removed, is known as 'oleo-mar- 
garine oil.' The next step in the process is 'churn- 
ing. ' The oil is allowed to run into churns containing 
milk and a small quantity of coloring material 
(annatto), where, by means of rapidly revolving pad- 
dles, it is churned for about an hour. When this part of 
the process is complete, the substance is drawn off from 
the bottom of the churn, into cracked ice. When cool, 
it is taken from the ice, mixed with a proper quantity 
of salt, and is then worked like butter and put into 
firkins for the market. It is also moulded into attrac- 
tive prints, in imitation of dairy butter. * When the 
materials from which oleo-margarine is made are sweet 
and clean, and when the process of manufacture is prop- 
erly conducted, the resulting product is an entirely 
harmless article, and probably differs very little in nu- 
tritive value from butter itself. 

Cheese. — The value of cheese as a food depends 
upon the large amount of proteids and fat which it 
contains. The rich varieties of cheese, such as Fro- 
mage de Brie and Roquefort, contain on an average 
thirty per cent, of fat, and twenty-seven per cent, of 
proteid compounds. Parmesan contains only about 
eight per cent, of fat, and nearly thirty-three per cent, 
of proteids, while Edam and Chester cheese which may 
be considered as 'standing about midway between the 
above, contain twenty per cent, of fat, and nearly 
twenty-eight per cent, of proteids. From these fig- 
ures it appears that cheese is one of the most nutritious 
aliments obtainable, but it cannot be eaten in large 
quantities at a time, as it is exceedingly liable to cause 
disturbances of the digestive organs. The constipat- 
ing property of cheese is well-known to the public. 

Cheese is not often adulterated. The only articles 

* Dr. W. K. Newton, Fifth Annual Report of the State Board of Health of New 
Jersey, 18H1, p. 107, 



68 TEXT-BOOK OF HYGIENE. 

used with success in its sophistication are lard and 
oleo-margarine, which are incorporated with the casein 
during the process of manufacture. It sometimes un- 
dergoes chemical changes which render it intensely 
poisonous when eaten. 

Meat. — The flesh of mammals, reptiles, birds, fish, 
and invertebrate animals is used as food by man. 
Falck*has classified the varieties of animals which fur- 
nish food to the inhabitants of Europe. There are forty- 
seven varieties of the mammalian class, one hundred 
and five of birds, seven of amphibia, one hundred and 
ten of fish, and fifty-eight of invertebrates. 

Meat is the most important source of proteids in 
the food. In the more commonly used varieties of meat, 
the proteids and fats constitute from twenty-five to 
fifty per cent, of the entire bulk, the proportion de- 
pending largely upon the age of the animal and its 
bodily condition. The following table shows the in- 
fluence of these two factors upon the relative propor- 
tions of the fats and proteids contained in the meat : 



Moderately Fat Beef. 

Lean Beef. 

Veal, 

Very Fat Mutton 

Fat Pork. 

Lean Pork. 

Fare. 

Lean Chicken. - 



Paris in 


lOO.t 


PROTEIDS. 


FATS. 


21.39 


5.19 


20.54 


1.78 


10.88 


7.41 


14.80 


36 39 


14.54 


37.34 


19 91 


6.81 


23.34 


1.13 


19.72 


1.42 



The flesh of animals, which is neutral in reaction im- 
mediately after death, soon becomes acid in consequence 
of the formation of lactic acid. The acid, acting upon 
the sarcolemma and the muscular fibre, renders it softer 
and more easily permeable by fluids when cooking, 
and more susceptible to the action of the gastric juice 
when the meat is taken into the stomach. 

* Das Fleisch ; Gemeinverstasndliches Handbuch der Wissenschaftlichen und 
Praktischen Pleisehkunde. 

t Abridged from Loebisch ; article 'Fleisch' in Realencyclopsedie d. ges. Heil- 
kunde. Vol. 5, p. 340. 



FOOD. 69 

Certain kinds of meat, — mutton and venison for 
example, are often kept so long before being eaten, that 
a considerable degree of putrefaction has taken place 
when they are brought upon the table. The wisdom 
of this practice is questionable from a hygienic point 
of view. 

Meat is sometimes eaten raw, but it is usually first 
cooked. The methods of cooking in general use are boil- 
ing, frying, roasting, broiling and baking. By either of 
these methods of cooking, when properly carried out, the 
nutritious properties of the meat are preserved and it 
is rendered digestible. The culinary art deserves the 
closest attention of students of hygiene. 

A. number of soluble preparations of meat, (beef 
extract, beef essence, beef juice) are found in the 
market and highly recommended as containing all the 
nutritious qualities of the meat from which they are 
prepared. These, and similar products of domestic 
preparation, (broths and teas) contain in reality very 
little nutritive material, but are of use almost solely 
as stimulants to the appetite and digestion. They 
have a place in the dietary of the sick, but their nutri- 
tive value is small. 

Meat may be unfit for food from various causes. 
Thus the flesh of animals dying from certain diseases ; 
splenic fever, pleuro-pneumonia, tuberculosis in its ad- 
vanced stages, cow or sheep-pox should not be used as 
food when it can be avoided. Cases are on record 
proving the poisonous character of meat from animals 
which suffered, at the time of death, from some of the 
above mentioned diseases. The most important condi- 
tion to be borne in mind is that certain parasites, (tri- 
china spiralis, echinococcus, cysticercus) which fre- 
quently infest the flesh of animals, especially hogs, not 
infrequently give rise to serious or even fatal diseases 
in persons consuming such meat. Any meat contain- 



70 TEXT-BOOK OF HYGIENE. 

ing these parasites, or suspected of containing them, 
should therefore not be used as food unless precau- 
tions be first taken to destroy the life of the parasite. 
Of the parasites mentioned, the trichina spiralis is 
the most important in this connexion, as it frequently 
occurs in the flesh of hogs, rats, dogs, cats and other 
carnivorous animals. Rats are said to be infested with 
the parasite more frequently than any other animals. 
The trichinae are found in two forms, one the mature 
form, inhabiting the intestinal canal. The immature 
form, or muscle trichinae, are found in striped muscle, 
coiled into spirals and encysted in a fibrous capsule. 
They gain access to their host in the following manner : 
Flesh containing living trichina? is taken into the .stom- 
ach, where the muscular tissue and the fibrous envelope 
are dissolved, and the enclosed worms set free. These 
mature in the intestinal canal, where sexual reproduc- 
tion takes place, and the young embryos pass through 
the intestinal walls and other tissues until they become 
imbedded in striated muscle. Localized epidemics of 
trichinosis have been reported in this country and 
Europe, and in nearly every instance the source of the 
disease has been traced to the ingestion of uncooked 
pork. Meat known to be trichinous should not be used 
unless in times of great scarcity. It may, however, 
be rendered innocuous by thorough cooking. A tem- 
perature of 140°-160° F., destroys the life of the para- 
site and renders the meat safe. On account of the fre- 
quent occurrence of trichina? in pork, this meat should 
never be eaten unless thoroughly cooked. It has been 
ascertained that salted and smoked pork is not free 
from danger, as the parasites are not killed in the pro- 
cess of curing the meat. Hence ham and sausage 
should not be eaten raw, as the danger from these ar- 
ticles is almost equally as great as from fresh pork. 






FOOD. 71 

Certain animals can devour with impunity sub- 
stances which are intensely poisonous to human beings. 
The flesh of the animals may be impregnated with 
these poisons, and cause serious and fatal illness in 
persons partaking of it. In this way may perhaps be 
explained the cases of poisoning sometimes following 
the eating of partridges and other birds. 

Crabs, oysters, lobsters and other shell-fish, when 
eaten out of season sometimes give rise to severe gastro- 
intestinal irritation. Prof. McSherry, of Baltimore, 
says he has seen all the gastro-enteric and nervous 
symptoms, called among the Spanish people of the 
West Indies by the name of siguatera, to designate a 
disease following the consumption of poisonous fishes, 
induced by eating oysters unseasonably. What has 
been said of oysters applies equally to lobsters and 
crabs. These marine luxuries all change readily, and 
if eaten out of season, or not perfectly fresh, are liable 
to cause enteric disease, cholera morbus, or siguatera.* 
Some persons are also affected by an idiosyncrasy, on 
account of which they cannot indulge in shell-fish with- 
out the most serious discomfort, manifesting itself at 
one time by a violent outbreak of urticaria, at another 
by the gastro-intestinal affections above referred to. 
These attacks may occur even when the food is entirely 
fresh. 

During the putrefactive processes in meat certain 
poisonous compounds are formed in the tissues which 
cause symptoms of poisoning in those who use such 
meat as food. Numerous cases have been reported 
where sausages, fish, canned meats and similar articles 
have given rise to serious or even fatal illness. In 
most of these instances, the meat has undergone some 
degree of putrefactive decomposition when it was used. 
It is believed that the poisoning in these cases is due 

* Health and How to Promote it. New York, 1879, p, 143. 



72 TEXT-BOOK OF HYGIENE. 

to the action of ptomaines, which are produced during 
the decomposition of meat in the absence of oxygen. 
These compounds have been shown by Selmi and others 
to be intensely poisonous. In some cases of poisoning 
by canned meats, it is not improbable that the symp- 
toms were due to lead poisoning. Most of the cans used 
for preserving meats, vegetables and oysters, permit 
contact between the fluids within the can and the lead 
used for sealing them. Recently an improvement has 
been introduced in this respect, and cans are now made 
in which all contact between the solder and the con- 
tents of the cans is prevented.* 

The prevention of disease from tainted meat is 
one of the most important problems of public hygiene. 
Pood animals should be inspected by qualified inspec- 
tors before slaughtering, to exclude animals suffering 
from diseases that would vitiate the meat. "When the 
meat is exposed for sale upon the dealer's stall, it 
• should be again inspected, and all found unfit for use 
as food, confiscated and destroyed. Meat, in which 
the presence of trichinae or other parasites is suspected 
should be examined microscopically. f 

Eggs. — Although eggs contain a large amount of the 
proteid and fatty alimentary principles, their value as 
food has probably been greatly overrated. The savory 
taste and ready digestibility of eggs has, however ren- 

* In a paper read before the New York Medico-Legal Society. Dr. Jno. G. John- 
son, (Sanitarian. June, 1J384), reported six cases of poisoning from eating canned toma- 
toes Dr. Johnson attributes the symptoms to the effect of muriate of zinc and mu- 
riate of tin, which he believes to have gained access to the can in the process of seal- 
ing. The muriate of zinc is used as a flux in soldering and the excess of acid dissolves 
the tin from the internal face of the cap. No chemical examinations were made, how- 
ever, to demonstrate this opinion. 

t The prevention of the diseases of animals by National and State authorities, 
is one of the most logical and thoroughgoing means of preventing disease from un- 
wholesome meat. The American Public Health Association has for some years devo- 
ted considerable attention to the investigation of the diseases of animals, and means 
for their prevention. The Department of the Interior of the-National Government 
lias likewise made the diseases of cattle and hogs a subject of study and published 
some valuable reports thereon. 



FOOD. 73 

dered them a popular article of food. For obvious rea- 
sons, the eggs of the common barn-yard fowl are most 
frequently used, those of ducks and geese being far in- 
ferior in flavor to the first named, and being likewise 
less easily obtained. 

The method of cooking eggs is generally supposed 
to have considerable influence upon their digestibility. 
According to Dr. Beaumont's experiments made on 
Alexis St. Martin, raw eggs are digested in one and a 
half to two hours, fresh roasted in two hours and fif- 
teen minutes, soft boiled or poached in three hours, 
and hard boiled or fried in three and a half hours. 
These experiments are, however, of very little value 
as a basis for general conclusions. It is probable that 
a hard-boiled egg is quite as easily digested in the 
healthy stomach as a raw one, if care be taken to mas- 
ticate it well and eat bread with it, so that it is intro- 
duced into the stomach in a finely divided state. 

Eggs readily undergo putrefaction, when sulphu- 
retted hydrogen is formed in them in large quantities. 
When this has taken place they are manifestly unfit 
to be used as food. 

FOODS OF VEGETABLE ORIGIN. 

Bread. — The various cereal grains, when ground 
into flour, are used in making bread. The flours of 
wheat, rye, barley, buckwheat and Indian corn are almost 
exclusively used in breadmaking. Of these, rye flour 
is richest in gluten — the nitrogenous principle — while 
corn meal contains most starch. The bran, or cortical 
portion of grain contains a larger percentage of pro- 
teid principles than the white internal portion, hence, 
flours made from the whole grain, (bran flour, Graham 
flour) if finely ground are more nutritious than the 
white flours. The latter are however more digestible. 



74 TEXT-BOOK OF HYGIENE. 

Good bread should be light, porous and well baked. 
The lightness and porosity are due to carbonic acid gas, 
imprisoned in cavities of the dough during the process 
of bread making. By adding yeast to the dough a fer- 
mentation is caused in the latter, in consequence of 
which a portion of the starch is converted into sugar, 
and then into alcohol and carbonic acid. During the 
process of mixing the dough, the entire mass becomes 
permeated by the gas, which, on heating, expands and 
leaves the numerous large and small cavities throughout 
the loaf which indicate properly made bread. 

Instead of yeast, some persons use leaven, which 
is simply a portion of fermenting dough, saved from a 
previous baking. A small quantity of this added to a 
mass of dough starts up the fermentation in a similar 
manner to that of yeast. 

The production of carbonic acid by fermentation 
in the dough, goes on at the expense of part of the 
starch. It has been proposed, therefore, to supply the 
carbonic acid from without, thus saving the entire 
amount of the carbo-hydrates present in the flour. 
This is accomplished in two ways. First, by the use 
of some alkaline carbonate or bicarbonate (bicarbonate 
of sodium, carbonate of ammonium), the carbonic acid 
being set free on the application of heat, or secondly, 
by forcing the gas, previously prepared, into the dough 
by means of machinery. 

Flour is not infrequently adulterated with chalk, 
pipe-clay and similar articles. These are easily de- 
tected by adding a mineral acid which produces effer- 
vescence when it comes in contact with the alkaline 
carbonate used as adulterant. Bakers often mix alum 
with inferior grades of flour. This imparts a greater 
degree of whiteness to the bread, and, in addition, en- 
ables it to retain a large proportion of water, thereby 
increasing the weight of the loaf. 



FOOD. 75 

Formerly diseased grain (ergotised rye) often caused 
outbreaks of disease when the flour made from the dis- 
eased grain was used in bread-making. At the present 
time such accidents rarely occur. In some parts of 
Italy it is said that an endemic disease, — pellagra, — is 
caused by the consumption of diseased Indian corn. 
The evidence in favor of this view is, however, not 
unquestioned. 

Potatoes and rice are often used with satisfaction 
as substitutes for bread. They both contain a large pro- 
portion of carbo-hydrates, and when properly cooked, 
are very palatable and easily digestible articles of food. 
Indian corn(hominy) and oatmeal are likewise wholesome 
and nutritious foods of this class. 

The leguminous seeds, (beans, peas, lentils) furnish 
a food containing a large percentage of proteids. Ac- 
cording to the analyses of Kcenig* the average compo- 
sition of the most frequently used legumes in the dried 
condition is as follows : 

BEANS. TEAS. LENTILS. GROUND-NCTS.t 

Water, per ct. - 

Solids, " 

Proteids, ... 

Fats, .... 

Carbo hydrate*, 

Cellulose, 

Ash, .... 

Beans, peas and lentils are often added to other 
articles of food with advantage. In recent years an 
important article of food for armies has been made of 
various legumes ground into flour and mixed with fat, 
dried and powdered meat, salt and spice. This consti- 
tutes the so-called 'Erbswurst,' which formed such an 
important part of the dietary of the German army 
in the Franco- German war of 1871. Bean and pea 
meal is also used sometimes as an addition to other 
flours in bread-making. The dried leguminous fruits 

* Die Menschlichen Nahrungs-und Genussmittel, II., p. 288, 
t The American pea-nut, the fruit or nut of aiac/ds hypog<ea. 



13 6 


14.3 


12.5 


6.5 


86.4 


85.7 


87.5 


93.5 


28.1 


22.6 


24.8 


28.2 


2.3 


1.7 


19 


46.4 


53.0 
3.9 


53.2 
5.5 


54.7 ) 
3.6 C 


15.7 


3.5 


2.7 


2.5 


3.2 



76 TEXT-BOOK OF HYGIENE. 

cannot be used as regular articles of diet, however, as 
they soon pall upon the taste, and produce indigestion, 
nausea and other intestinal derangements. 

Green Vegetables. — The plants usually classed to- 
gether as 'vegetables,' the products of the market 
garden or truck farm, comprise cabbages, turnips, pars- 
nips, onions, beets, carrots, tomatoes, lettuce, green 
peas and beans and similar articles. They all contain 
a large proportion of water, a variable proportion of 
sugar, and a small percentage of proteid principles. 
Much of their palatability and digestibility depends 
upon the method by which they are prepared for the 
table. All garden vegetables should be used soon after 
being gathered, as they rapidly undergo decomposition, 
and are liable to produce derangements of the diges- 
tive organs if used under these conditions. 

Fruits and Nuts generally contain large quantities 
of sugar and fats. They form agreeable additions to 
other articles of diet, but are insufficient to sustain 
life. The use of fruits usually produces copious intes- 
tinal evacuations, and they are therefore especially to 
be recommended to persons of sedentary occupations, 
in whom torpidity of the bowels is so frequently present. 

Condiments. — Various aromatic herbs and seeds 
are used as additions to other articles of food to in- 
crease their sapidity, and to promote a larger flow of 
saliva and gastric juice, and so assist digestion. Mus- 
tard, pepper, alspice and vinegar are the principal con- 
diments. Within certain limits they are not injurious, 
but the tendency in the use of all stimulants is to ex- 
ceed the healthful limit. Condiments, as well as other 
stimulants, should be used in moderation. 

COOKING. 

Much more attention than is generally given should 
be paid by physicians to the culinary art. The man- 



FOOD. 77 

ner in which food is cooked has no little influence upon 
its digestibility. There can be no question that the 
extreme prevalence of functional indigestion in this 
country is almost exclusively dependent upon bad 
cooking. 

The various methods of cooking are boiling, fry- 
ing, roasting, broiling and baking. By either of these 
methods food can be cooked so as to be palatable as 
well as digestible; on the other hand the choicest 
article can be utterly spoiled and rendered unfit to be 
taken into the human stomach. It depends, therefore, 
not so much upon the method of cooking, as upon the 
knowledge and art of the cook. 

Boiling. — Meats of all kinds are rendered tender 
and digestible by boiling. In order to retain the flavor 
of meat, the water should be boiling when the meat is 
put into it. By the heat of the boiling water the al- 
bumen on the outside of the meat is coagulated and 
the juices and flavor retained within. After a few 
minutes the temperature of the water should be reduced 
to 160-170° P.", and maintained at that height until the 
meat is tender. By this process a much more savory 
piece of beef, mutton or fowl can be obtained, than 
where the meat is put into cold water and this grad- 
ually heated. The latter method is, however, the 
proper one to be followed when good soup or broth is 
desired. 

In boiling vegetables, as much care is necessary as 
in boiling meat or fish. Potatoes and rice should be 
steamed, rather than boiled. 

The difficulty of obtaining a good cup of coffee, 
especially in the Northern portion of the United States, 
illustrates the prevailing ignorance upon one of the 
simplest points in the art of cooking. Coffee should 
never be served in the form of a decoction, that is to 
say, it should never be boiled. Properly made it is an 



78 TEXT-BOOK OF HYGIENE. 

infusion, like tea, which no one ever thinks of boiling. 
The difference between an infusion (especially if made 
by percolation) and a decoction of coffee can only be 
appreciated by those who have enjoyed the one, and 
endured the other. 

Frying. — Frying, if properly done, is really nothing 
less nor more than boiling in oil or fluid fat of some 
kind. Olive oil is preferable but is not essential ; but- 
ter, beef-drippings, lard, or probably cotton seed oil 
may be substituted for it without disadvantage. The 
principle of frying depends upon the fact that the tem- 
perature of oil can be raised to such a height as to pro- 
duce instant coagulation of the surface of meat, fish or 
other object immersed in it while hot ; this film of co- 
agulated albumen imprisons the juices and flavors of 
the meat or fish, and prevents the fat entering and 
soaking the fibres with grease. Small fish or birds 
properly fried are justly regarded as delicacies by con- 
noisseurs, but the process of saturating these objects 
with fat while gradually heating them produces a dish 
that is anything rather than grateful to the palate, or 
conducive to good digestion. 

Roasting. — The fame of 'the roast beef of Old 
England' has passed into song, but at the present day, 
beef and other meats are rarely roasted, either in this 
country or abroad. As Sir Henry Thompson well ex- 
presses it,* 'the joint, which formerly turned in a cur- 
rent of fresh air before a well-made fire, is now half 
stifled in a close atmosphere of its own vapors, very 
much to the destruction of the characteristic flavor of 
a roast.' It is probable that the old method of roast- 
ing before an open fire produced not only the most 
savory, but likewise the most nutritious and digestible 
meat. It is much to be regretted that the process has 
fallen so greatly into disuse. 

* Food and Feeding, London, 1880, p. 45. 



FOOD. 79 

Broiling and Baking. — These methods of cooking 
are modifications of the process of roasting. Meats or 
tisli carefully broiled or baked preserve their natural 
juices and flavors to a great extent, and retain their 
digestibility and nutritious properties. Of all methods 
of cooking these are probably best known and most 
satisfactorily applied in this country. 

A L 1 M ENTA BY BEVERAGES. 

The alimentary beverages may be divided into two 
classes. Those depending for their effects upon the 
alcohol they contain, and those whose active principles 
reside in certain alkaloids. They are used chiefly as 
digestive and nervous stimulants. 

BEVERAGES CONTAINING ALCOHOL. 

The physiological action of alcohol has been pretty 
fully worked out by Binz and his pupils, and by other 
experimenters. From these researches, it appears that 
the first effect of taking alcohol, sufficiently diluted, 
into the stomach, is to increase the flow of the saliva 
and gastric juice. This effect is probably reflex, and 
results from a stimulation of nerve terminations in 
the stomach. The alpohol is rapidly absorbed, and is 
carried in the blood, without undergoing chemical 
change, to the nervous centres, lungs and tissues general- 
ly. In the brain the alcohol probably enters into com- 
bination with the nervous tissue, modifying the normal 
activity of the various centres, either increasing the 
activity, if the alcohol is in small quantity, (stimulat- 
ing effect) or diminishing it, if in larger quantity, (de- 
pressing effect) or entirely suspending the activity of 
the centres, if in sufficiently large quantity, (paralysing 
effect). 

Alcohol stimulates the vaso-dilator nerves, caus- 
ing dilatation of the smaller vessels ; in consequence of 



80 TEXT-BOOK OF HYGIENE. 

this the blood is largely sent to the periphery of the 
body ; the blood pressure diminishes, and heat-radia- 
tion is increased. At the same time a portion of the 
alcohol is used up in the lungs in the production of 
animal heat, thus economising the expenditure of fats 
and proteids, and acting as a true respiratory food. 
Alcohol does not contribute nutritive material to the 
body ; it only permits that which is stored up to be 
saved for other uses, by furnishing easily oxidisable 
(combustible) material for carrying on the respiratory 
process, and supplying animal heat. 

During the use of alcohol the excretion of urea is 
diminished. This shows that waste of tissue is re- 
tarded in the body. 

Regarding the statement of some authorities that 
alcohol does not undergo any change in the body, but is 
excreted unchanged, Binz asserts* that alcohol appears 
in the urine only when exceptionally large quantities 
have been taken, and then in very small proportion. 
It is not excreted by the lungs, the peculiar odor of 
the breath being due not to the alcohol, but to the vol- 
atile aromatic ether, which is oxidised with greater 
difficulty and so escapes unchanged. 

While alcohol produces subjectively an agreeable 
sensation of warmth in the stomach and on the surface 
of the body, the bodily temperature is not raised. 
The subjective sensation is due to the dilatation of the 
blood vessels, and the sudden hyperemia of those parts. 

During fevers and other exhausting diseases, alco- 
hol is invaluable to prevent waste of tissue and sustain 
the strength. It does not act merely as a stimulant to 
the circulation and nervous system, but as above 
pointed out, saves the more stable compounds by fur- 
nishing a readily oxidisable respiratory food. 

* Realeneyclopsedia, d. ges. Heilk, Bd. I. p. 183. 



FOOD. 81 

When taken in small doses by healthy persons, 
alcohol diminishes the temperature by increasing heat- 
radiation. When large quantities are taken, the bodily 
temperature is reduced by diminishing heat produc- 
tion, as well as by increased radiation. This is shown 
in the condition known as dead-drunkenness, in which 
the temperature is sometimes depressed as much as 20° 
below the normal. Cases in which the temperature 
sank to 75°, 78.8° and 83° F. have been reported, with 
recovery in all the cases. 

The constant use of alcohol produces in all the 
organs an excess of connective tissue, followed by 
fatty degeneration and the condition known as cir- 
rhosis. The organs most frequently affected are the 
stomach, liver and kidneys. Serious pathological alter- 
ations also occur in the circulatory, respiratory and 
nervous systems. 

Alcohol is not necessary to persons in good health. 
Probably most persons, regardless of their state of 
health, do better without it. Its habitual use in the 
form of strong liquors is to be unreservedly condemned. 
The lighter wines and malt liquors, if obtained pure, 
may be consumed in moderate quantities without ill 
effects. Even in these forms however, the use of alco- 
hol should be discouraged, or perhaps prohibited in 
the young. 

Neither in hot, nor in cold climates is alcohol 
necessary to the preservation of health, and its moderate 
use even produces more injury than benefit. The Polar 
voyager and the East India merchant are alike better 
off without alcohol than with it. 

It has long been a prevalent belief that the use of 
alcohol enables persons to withstand fatigue better 
than where no alcohol is used. A large amount of con- 
current testimony absolutely negatives this belief.* 

* See Pakkes' Hygiene, 6th Ed., Vol. 1, p. 315-327. 



82 TEXT-BOOK OF HYGIENE. 

The predisposition to many diseases is greatly 
increased by the habitual use of alcohol. Sunstroke, 
the acute infectious diseases, and many local organic 
affections attack by preference, the intemperate. A 
recent collective investigation by the British Medical 
Association, brought out the fact that croupous pneu- 
monia, is vastly more fatal among the intemperate than 
among those who abstained from the use of alcoholic 
liquors. 

Alcohol as a beverage, is consumed in the various 
forms of spirits, wines, and fermented liquors. The 
varieties of spirits most frequently used are brandy, 
whiskey, rum and gin. They are all procured by 
distillation. 

Brandy is distilled from fermented grape juice 
and has a characteristic aromatic flavor. When pure 
and mellowed with age it is the most grateful to the 
palate of all distilled spirits. 

Whiskey is distilled from barley, rye, oats, corn 
or potatoes. Each of these has a peculiar flavor, 
depending upon the particular volatile ether formed 
during the distillation. Rye, barley and corn whiskeys 
are almost exclusively used in this country. 

Rum is distilled from molasses, and is a favorite 
ingredient in hot punches. It is often used with milk, 
eggs and sugar, in the preparation of egg-nogg, a 
highly nutritious, stimulating drink, which is often 
prescribed with great benefit in acute and chronic 
wasting diseases. 

Gin is an ardent distilled spirit flavored with oil 
of juniper. It has a widely-spread popular reputation 
as a cure for kidney diseases, but is probably oftener 
responsible for the production of these diseases than 
for their cure. 

All of the above mentioned liquors contain from 
forty to sixty per cent, of alcohol, and should always 



FOOD. 83 

be diluted before being taken into the stomach, in 
order to prevent the local irritant effects of the 
alcohol upon the gastric mucous membrane. 

\Y ine is the product of the alcoholic fermentation of 
the saccharine constituents of fruits. Wine is usually 
derived from the grape, though other fruits may also 
furnish it. The stronger wines, (sherry, port, madeira) 
contain from sixteen to twenty-five per cent, of alco- 
hol. The lighter wines (hock, red and white Bordeaux 
and Burgundy wines, champagnes) contain from six to 
fifteen per cent, of alcohol. Some also contain con- 
siderable free carbonic acid, (sparkling wines) of which 
the champagnes are types. The red and white Bor- 
deaux and Rhine wines are probably the least objec- 
tionable of these beverages for habitual use. They 
contain sufficient alcohol to be lightly stimulant, have 
a pleasant acid flavor, and are least likely to produce 
the bad effects which usually follow in the wake of 
the habitual use of the stronger wines, or ardent 
spirits. 

Preference should be given to the wines of domestic 
manufacture, on account of the great probability of 
adulteration of the favorite brands of foreign wines. 

Cider is the fermented juice of apples. It fre- 
quently produces unpleasant gastric and intestinal 
disturbances when drunk, on account of the large 
quantity of malic acid contained in it. Although it 
is usually ranked as a 'temperance drink' it is quite 
■capable of causing intoxication when consumed in 
large quantities. 

Beer is the fermented extract of barley, mixed 
with a decoction of hops and boiled. It should be 
prepared only of malt, hops, yeast and water, and 
should contain from three to four per cent, of alcohol, 
five to six per cent, of extract of malt and hops, two 
to four per cent, of lactic and acetic acids, and from 



84 TEXT-BOOK OF HYGIENE. 

one-fourth to one-half per cent, of carbonic acid. This 
ideal is however rarely attained in the article sold by 
the liquor dealer. Numerous adulterations are prac- 
tised on the unsuspecting consumer. The hops are 
frequently substituted by aloes, calamus and ginger, 
or by the more deleterious picric acid, or picrotoxin. 
The rich brown color, sweetness, body and creamy foam 
are produced by caramel and glycerine. The more 
expensive barley malt is substituted by starch and rice, 
or grape sugar and molasses. 

Ale, porter and brown-stout are merely varieties 
of beer — some containing more sugar, others more 
extractive matter. 

Beer and its correlatives have considerable dietet- 
ic value, owing not merely to the alcohol they contain, 
but largely to the sugar and acids entering into their 
composition. When used to excess, they often cause a 
considerable accumulation of fat. 

Koumyss is the national beverage of the nomadic 
tribes of Tartary. It consists of the milk of mares 
which has undergone partial fermentation. Recently 
it has been introduced into Europe and this country, 
where it is made of cow's milk. It is a palatable, 
nutritious stimulant, and is often useful as a dietetic 
article in disease. 

THE ALKALOID AL BEYEKAGES. 

The virtues of the alkaloidal beverages depend 
upon certain alkaloids which differ very little in their 
chemical composition or physiological effects, and upon 
certain volatile aromatic constituents of the various 
articles used. The principal articles employed in the 
preparation of these beverages are coffee, tea, chocolate, 
mat§ and coca. It is estimated that 500,000,000 peo- 
ple drink coffee, 100,000,000 tea, 50,000,000 chocolate, 
15,000,000 mat6 or Paraguay tea, and 10,000,000 coca. 






FOOD. 85 

All of these are active nervous stimulants and retard- 
ers of tissue-waste. They are all liable to produce 
serious functional disturbances of the nervous, digestive 
and circulatory systems if used to excess. Anemia, 
digestive derangements, constipation, pale, sallow com- 
plexion, loss of appetite, disturbed sleep, nervous 
headaches and neuralgias are the most marked of these 
effects. 

On the other hand, when taken in moderate 
quantity, the alkaloidal beverages enable the consumer 
to withstand cold, fatigue and hunger ; promptly 
remove the sensation of hunger, and diffuse a glow of 
exhilaration throughout the body. 

Coffee. — Coffee is the ripe fruit (seed) of the Caffea 
Arabica, a native of Arabia and Eastern Africa, but 
now cultivated in other tropical regions of the world. 
The fruit consists of two flat-convex beans, the flat 
surfaces of which are apposed to each other. These 
are enclosed in a fibrous envelope which is sometimes 
used as a cheap substitute for the coffee-bean. 

The beverage, coffee, is an infusion of the roasted 
and ground bean in hot water. Its virtues depend 
upon the alkaloid, caffein, and an aromatic oil. The 
latter, being volatile, is driven off by long-continued 
heat. Hence boiled coffee lacks the grateful aroma of 
that which is made by simply infusing the ground bean 
in hot water. 

The great demand for coffee, and its comparatively 
high price have caused it to be extensively adulterated 
and substituted by other natural and artificial products. 
Artificial coffee beans have been made of clay, dough 
or extract of chicory, colored to imitate the natural 
bean. The fraud is easily detected by placing the 
beans in water, when the artificial product soon falls 
to pieces, while the natural beans undergo no change of 
shape or consistence. 



86 TEXT-BOOK OF HYGIENE. 

Ground coffee as found in the stores is usually- 
adulterated. The materials used for sophistication are, 
the grounds of coffee previously used, the roasted root 
of chicory, acorns, rye or barley, carrots, sun flower 
seeds, caramel and a number of articles of similar value, 
generally harmless. 

Tea. — The plants which furnish the tea-leaves are 
natives of China, Indo-China and Japan. The tea- 
leaves contain a crystalline alkaloid, thein, identical in 
composition and properties with caffein. The various 
sorts of tea found in the market (green and black teas, 
etc.) differ only in the relative proportion of tannin 
and thein contained in each. The aromatic principle 
also varies somewhat in the different sorts. 

Tea is adulterated to quite as great an extent as 
coffee, the leaves of various plants bearing more or less 
resemblance to tea leaves being added to the latter. 
Much of the tea found in the market is colored 
artificially with Prussian blue and iron oxide. These 
additions are harmless, as they are not soluble in 
water. 

Chocolate. — Cocoa, from which chocolate is derived 
is widely different in composition from tea and coffee. 
In addition to its active principle, theobromin, which 
is identical with caffein and thein, it contains nearly 
50 per cent, of fat, which renders it an article of high 
nutritive value. 

Mat6, or Paraguay tea, guarana, and coca are 
used to a considerable extent in some parts of South 
America, as substitutes for coffee and tea. Their com- 
position is not well known, but their effects are believed 
to depend upon alkaloidal principles similar to caffein 
and thein. 

TOBACCO. 

Closely connected with the subjects treated in this 
chapter are the effects of the constant use of tobacco 



FOOD. 87 

upon the human system. The depressing effects of 
tobacco, due principally to the nicotin upon the ner- 
vous and digestive systems, have long been recognized. 
Recently however, it has been found that very serious 
symptoms are produced upon the sense of vision by the 
constant or excessive use of tobacco. A special form 
of amaurosis, termed tobacco amaurosis, has been 
frequently noticed since attention was first called to it 
by Mackenzie. 

[The following additional works are recommended 
to the student : 

Thos. K. Chambers, on Diet in Health and Disease. Edward Smith, 
on Foods. Forster, Ernahrung, in Pettenkofer u. Ziemssen's Handbuch 
der Hygiene.] 



CHAPTER IV. 

SOIL. 

Hippoceates treated at length, in one of his works, 
of the sanitary influences of the soil. Others of the 
older writers, especially Herodotus and Galen called 
attention to the same subject, and Vitruvius, the cele- 
brated Roman architect, who flourished about the 
beginning of the Christian era, taught that a point of 
first importance in building a dwelling was to select 
a site upon a healthy soil. 

From this time until the beginning of the eigh- 
teenth century, very little of value is found in medical 
literature bearing upon this subject. In 1717. how- 
ever, Lancisi published his great work on the causes 
of malarial fevers in which he laid the foundation for 
the modern theory of malaria, and pointed out the 
relations existing between marshes and low-lying lands 
and those diseases, by common consent, called mala- 
rial. Other authors of the eighteenth, and the early 
part of the nineteenth century, refer to the connexion 
between the soil and disease, but exact investigations 
have only been made within the last thirty years. 

When it is considered that the air that human 
beings breathe, and much of the water they drink, are 
influenced in their composition by the matters in the 
soil, the great importance of possessing a thorough 
knowledge of the physical and chemical conditions of 
the soil becomes evident to every one. 

PHYSICAL AND CHEMICAL CHAEACTEKS OF THE SOIL. 

In the hygienic, as in the geological sense, rock, 
sand, clay and gravel are included in the consideration 
of soils. 



soil. 89 

The soil, as it is presented to us at the surface of 
the earth, is the result of long ages of disintegration of 
the primitive rocks by the action of the elements, of 
the decomposition of organic remains, and possibly, of 
accretions of cosmical dust. The principal factor, 
however, is the action of water upon rock, in leveling 
the projections of the earth's surface produced by vol- 
canic action. 

Soils vary considerably in physical and chemical 
constitution. A soil may, for example, consist exclu- 
sively of sand, of clay, or of disintegrated calcareous 
matter. Other soils may consist of a mixture of two 
or more of these, together with vegetable matter under- 
going slow oxidation. In forests, a layer of this slowly 
decomposing vegetable matter of vapying thickness is 
found, covering the earthy substratum. This organic 
layer is called humus, and when turned under by 
plough or spade, and mixed with the sand or clay 
base, it constitutes the ordinary agricultural soil. 

THE ATMOSPHERE OF THE SOIL, OR GROUND AIR. 

The interstices of the soil are occupied by air or 
water, or by both together. The soil' s atmosphere is 
continuous with, and resembles in physical and chem- 
ical properties that which envelopes the earth. Its 
proportion to the mass of the soil depends upon the 
degree of porosity of the soil and upon the amount of 
moisture present. In a very porous soil, such as, for 
example, a coarse sand, gravelly loam or coarse-grained 
sandstone, the amount of air is much greater than in a 
clayey soil, granite, or marble. So, likewise, when the 
soil contains a large proportion of water the air is to 
this extent excluded. The porosity of various soils, 
as evidenced by the amount of air contained in them, is 
much greater than would, at first thought, be sup- 



90 • TEXT-BOOK OF HYGIENE. 

posed. Thus it has been found that porous sandstone 
may contain as much as one-third of its bulk of air, 
while the proportion of air contained in sand, gravel 
or loose soil may amount to from thirty to fifty per 
cent. 

The ground- air is simply the atmospheric air which 
has penetrated into the interstices of the soil and taken 
part in the various chemical decompositions going on 
there. In consequence of these chemical changes the 
relative proportions of the oxygen and carbonic acid 
in the air are changed — oxygen disappearing and 
giving place to carbonic acid. It is well-known that 
during the decay of vegetable matter in the air, car- 
bonic acid is formed; one constituent of this com- 
pound, the carbon being derived from the vegetable 
matter, while the oxygen is taken from the air. Hence, 
if this action takes place where there is not a very free 
circulation of air, as in the soil, the air there present 
soon loses its normal proportion of oxygen, which 
enters into combination with the carbon of the vegeta- 
ble matter to form carbonic acid. 

Thirty years ago, MM. Boussingault and L6vy, 
two distinguished French chemists, examined the air 
contained in ordinary agricultural soil, and found that 
the oxygen was diminished to about one-half of the 
proportion normally present in atmospheric air, while 
the carbonic acid was enormously increased. The 
exact results obtained by Boussingault and Levy were 
as follows : 

In one hundred volumes of ground air there were 
10.35 volumes of oxygen, 79.91 volumes of nitrogen, 
9.74 volumes of carbonic acid. In atmospheric air, on 
the other hand, there are in one hundred volumes 20.9 
volumes of oxygen, 79.1 volumes of nitrogen. 0.04 
volumes, or about one twenty-fifth of one per cent., of 
carbonic acid. 



SOIL. 91 

In spite of the striking results obtained by these 
two chemists, very little attention was paid to them by 
sanitarians, as very few seemed to have any clear 
notion of the relations existing between the motions of 
the air above ground and that under ground. 

In 1871, however, Prof. Von Pettenkofer, of 
Munich, published the results of his own examinations 
into the constitution and physical conditions of the 
ground air, and the relations of the latter to the 
propagation of epidemic diseases. These researches, 
which created a wide-spread interest in the subject, 
were extended by other observers in all parts of the 
world. These observers, prominent among whom were 
Professors Fleck and Fodor, in Germany ; Drs. Lewis 
and Cunningham, in India ; Prof. Wm. Ripley Nichols, 
in Boston, and Surgeons J. H. Kidder and S. H. Griffith 
of the U. S. Navy, in Washington, demonstrated that 
the increase of carbonic acid in the ground air is due 
to increased vegetable decomposition and to lessened 
permeability of the soil. A permeable, that is to say, 
a sandy or gravelly soil, is likely to contain less 
carbonic acid in its atmosphere than a dense, less 
permeable clay, although the amount of decomposition 
going on, and the production of carbonic acid in the 
former may considerably exceed the latter. In the 
loose sandy soil, the circulation of the air is less 
obstructed, and the carbonic acid may easily escape 
and be diffused in the superincumbent air, while the 
close-pored clay imprisons the carbonic acid and 
prevents or retards its escape into the air above. 

The disappearance of oxygen from the ground 
atmosphere is coincident with the production of an 
equivalent amount of carbonic acid. It appears from 
this that in the soil an oxidation of carbonaceous 
substances takes place, the product of which is the 
excess of carbonic acid in the ground air. 



92 TEXT-BOOK OF HYGIENE. 

Prof. Nichols -has found the proportion of carbonic 
acid in the air taken from a depth of ten feet below the 
surface in the 'made-land' of Boston, amount to 21.21 
per thousand, the observation being made in August. 
In December, at a depth of six feet, the proportion 
was 3.23 per thousand. Fodor, in Buda-pesth, found 
the proportion of carbonic acid to be 107.5 per thous- 
and (over 10 per cent.), the air being taken from a depth 
of thirteen feet. 

Movements of the ground-atmosphere are prin- 
cipally due to differences of pressure and temperature 
in the air above ground. Owing to such differences 
the air from the soil frequently permeates houses, 
entering from cellars'or basements. In winter, when 
the air of houses is very much more heated, (and con- 
sequently less dense) than the air out of doors, the 
difference of pressure, thus caused, draws the ground- 
air up through the house, while the cold external 
atmosphere penetrates the soil and occupies the place 
of the displaced ground-air.* A similar effect occurs 
in consequence of heavy rains. The water fills up the 
interstices of the soil near the surface and forces the 
ground-air out at points where the pores remain open. 
These places are the dry ground under buildings, 
where the air escapes and passes through floors and 
ceilings into the house above. Heavy rains may thus 
be the cause of pollution of the air in houses. The 
greater the porosity of the soil, the more likely is this 
to happen. This pollution of the house-air may be 
prevented by having impervious floors and walls to 
cellars and basements, or by interposing a layer of 
charcoal between the ground and the floor of the house. 
The latter does not prevent the passage of the ground- 

* It is, of course, not strictly correct to say that the air- is drawn up through the 
house by the diminution of pressure : it being rather forced out of the soil by the 
colder and denser outside air : but the phrase is sufficiently exact and will be readily 
understood. 



soil. 93 

air, but the charcoal layer absorbs the noxious matters, 
— filters the ground air, as it were. 

In the spring and early summer the ground being 
colder than the air above it, and the ground-air conse- 
quently heavier and denser, the latter is not easily dis- 
placed. It is perhaps due to this fact that those infec- 
tious diseases which are probably dependent upon the 
movements of the ground-air are less prevalent in the 
spring and early summer than in the latter part of 
summer, autumn and early winter. In the autumn 
the ground- air being warmer than the air above ground 
is easily displaced by the latter and forced out into 
the streets and houses to be inspired by men and ani- 
mals. The same conditions may explain the greater 
likelihood of infection at night, which is proven for 
such diseases as malarial and yellow fevers. The 
colder outside air penetrates the interstices of the soil 
and forces out the impure ground-air. 

The researches of Fodor have demonstrated that 
the proportion of carbonic acid in the ground-air may 
be taken as an approximative measure of the impurity 
of the soil whence the air is taken. The influence of 
the permeability of the soil, as before pointed out, must 
however not be overlooked in estimating the significa- 
tion of the carbonic acid. Fodor has shown that the 
proportion of carbonic acid in the ground-air, and con- 
sequently the amount of organic decomposition, is 
greatest in July and least in March. That the carbonic 
acid is derived from the decomposition of vegetable 
matter, has been proven by Pettenkofer. This observer 
examined specimens of air brought from the Lybian 
desert, and found that the proportion of carbonic acid 
in the ground-air was exactly the same as in the air 
collected above ground. There being no vegetable 
growth in the desert there can, of course, be no veg- 
etable decomposition going on in the soil. 



94 TEXT-BOOK OF HYGIENE. 

The excess of carbonic acid in the ground-air is an 
indication of the deficiency of oxygen as has been 
shown. The air at a depth of thirteen feet below the 
surface was found to contain only from seven to ten 
per cent, of oxygen — one-half to one third of the nor- 
mal proportion. Many basements occupied by people 
as living rooms extend from five to ten feet underground, 
and hence are liable to be supplied with an atmosphere 
approaching in impurity that just mentioned. It 
requires no very vivid imagination to appreciate the 
dangers to health that lurk in such habitations. 

THE WATEK OF THE SOIL, OR GROUND-WATER. 

At a variable depth below the surface of the 
ground, a stratum of earth or rock is found through 
which water passes with difficulty, if at all. Above 
this, there is a stratum of water which moves from a 
higher to a lower level, and which varies in depth at 
different times according to the amount of precipita- 
tion (rain or snow-fall) and according to the level of 
the nearest body of water toward which it flows. This 
stratum of water is termed the ground-water, and has 
within the last few years assumed considerable impor- 
tance from its apparently close relations to the spread 
of certain of the infectious diseases. The direction of 
horizontal flow of the ground-water is always toward 
the drainage-area of the district. Thus, it is usually 
toward lakes, rivers or the sea. Rains, or a rise in the 
river cause a rise in the ground- water, while long con- 
tinued dry weather, or a low stage of the river which 
drains off the ground-water causes a fall in the latter. 
On the sea-coast the ground- water oscillations probably 
correspond with the tides. The writer is not aware of 
any observations made to determine this point, with the 
exception of a single instance mentioned by Dr. De 
Chaumont. In Munich, where the ffround-water flows 



soil. 95 

toward the river Isar, which divides the city, it has 
been found that the annual range or oscillation (the 
difference between the highest and lowest level during 
the year) is ten feet, while the horizontal movement 
amounts to fifteen feet per day. In Buda-pesth the 
annual range was found by Fodor to be less than three 
feet, while in some portions of India it amounts to 
more than forty feet. As it is from the ground-water 
that the greater portion of the supply of drinking water 
in the country and in villages and small towns is drawn, 
it becomes at once manifest how important it is to pre- 
vent, as far as possible, pollution of this source. Cess- 
pools and manure-heaps and pits, of necessity, contam- 
inate the soil, and also ground-water for a distance be- 
low and around them, and such water is clearly unfit 
for drinking and other domestic purposes. Hence, the 
reason why wells should not be placed too near privies 
and manure-heaps or pits, becomes apparent. 

Between the level of the ground-water, or that 
portion of the soil where its pores are entirely occupied 
by the water — where, in other words, the ground is 
saturated — and the surface, is a stratum of earth more 
or less moist; that is to say, the interstices of the soil 
are partly filled with water and partly with air. It is 
in this stratum that the processes of organic decay or 
putrefaction are going on, in consequence of which the 
pollution of the ground-air occurs. The oxidation of 
non-nitrogenous matter in the soil results in the forma- 
tion of carbonic acid. On the other hand, nitrogenized 
compounds are oxidised into nitric acid and nitrates. 
When, however, putrefaction occurs, nitrous acid, or 
nitrites and ammonia are formed, the oxidation not 
proceeding far enough to result in nitric acid. 

Recent observations seem to show that these 
processes of decomposition are initiated and kept up 
by minute organisms termed bacteria, just as fermenta- 



yb TEXT-BOOK OF HYGIENE. 

tion in liquids containing sugar can only take place in 
the presence of the yeast plant. It has been found 
that when non-putrefactive decomposition goes on, there 
are always present multitudes of one variety of these 
minute organisms ; while if putrefactive decomposition 
is going on, a number of other varieties of these 
organisms are present. Just as, when a fermenting 
liquid becomes putrid, the yeast plant disappears and 
its place is taken by the ordinary bacteria of putrefac- 
tion, so in the soil, if the access of oxygen which is 
necessary to the life of the bacteria of decay, is 
prevented, these organisms die and are succeeded by 
the organisms of putrefaction. It has been found that 
in a soil saturated with water the bacteria of decay 
cannot live, while those of putrefaction may flourish, 
because these latter organisms can sustain life, and 
develope in the absence of oxygen. Prof. Fodor's 
researches indicate that the organism of non-putrefac- 
tive decomposition or decay is that which is termed by 
Cohn bacterium Mneola; and that the bacterium termo 
is the principal organism of putrefaction. 

DISEASES SPEEAD BY SOIL IMPUKITIES. 

Given now an area of soil, say the ground upon 
which a house or city is built, with a moist stratum in 
which the processes of decay are active, and imagine a 
rise in the ground-water. The ground-air, charged 
with carbonic acid and other products of decomposition, 
is forced out of the pores of the soil by the rising 
ground-water, and escapes into the external air. or 
through cellars and basements into houses and may 
there produce disease. But the saturation of the soil 
with water prevents the further development of the 
bacteria of decay, and this is checked, or, putrefaction 
may take place. If now, the ground-water sinks to its 
former level or below, the processes of decay again 



SOIL. 07 

become very active in the moist stratum, and large 
quantities of carbonic acid and other inorganic 
compounds are produced. If the germs of infectious 
or contagious diseases have been introduced into the 
soil, they also multiply and may escape with the 
movements of the ground-air into the external 
atmosphere and there produce their infective action. 
This, it is held by Pettenkofer and his followers is 
what actually occurs in cholera and typhoid fever. 
Prof. De Chaumont has laid down the rule that a soil 
with a persistently low stage of ground-water, say 
fifteen feet below the surface of the ground, is healthy : 
a persistently high stage of ground-water, less than 
five feet below the surface, is unhealthy, while a 
fluctuating level of the ground-water, especially if the 
changes are sudden and violent, is very unhealthy. 
This would lead us to expect that places where this 
fluctuation is very great would show a large mortality 
from such diseases as are attributed to impurities in 
the soil. And this we find especially true in India.- 
In certain localities in India, cholera, for example, is 
endemic — that is to say, the disease is never entirely 
absent in such localities. Calcutta is one of these places. 
The rainy season begins about the first of May and 
continues until the end of October. During the next 
six months there is very little rain. It is fair to assume 
that the ground-water rises during the rainy season 
and checks decay and the multiplication of the germs 
of the disease in the soil, and that these processes become 
more active as the dry season advances and the ground- 
water level falls. If we note the death-rate from chol- 
era in Calcutta it will be found that it bears a distinct 
relation to the movement of the ground-water. The 
deaths from cholera begin to increase from October and 
reach their height in April. Dr. Macpherson, who has 
written a very elaborate history of Asiatic cholera, 



98 TEXT-BOOK OF HYGIENE. 

shows this relation very clearly. For twenty- six years 
the average rainfall was sixty-three inches. From 
May to October fifty-seven inches fell, while the remain- 
ing six inches fell from November to April. The aver- 
age number of deaths from cholera annually was four 
thousand and thirteen. ' Of these, one thousand two 
hundred and thirty-eight died in the rainy season, while 
two thousand seven hundred and seventy-five, nearly 
three-fourths, died during the period of dry weather. 

In the cholera epidemics of 1866 and 1873 in Buda- 
pesth, the same relations existed between the ground- 
water and the cholera. As the level of the ground- 
water rose the cholera diminished, while the disease 
increased upon the sinking of the ground-water. Ex- 
actly the same behavior was exhibited by the disease in 
Munich in 1873. 

There seems good reason to believe that typhoid fever 
is propagated in consequence of movements of the ground- 
water, in the same way as above explained for cholera. 
This does not exclude the infection of drinking water 
by the disease-germ, since much of the drinking water 
used, as before stated, is drawn from the ground- water. 
Pettenkofer, Buhl and Virchow, have shown that the 
death-rate from typhoid fever has a distinct and defi- 
nite relation to the ground-water oscillations. This 
has been incontestably proven for two cities, Munich 
and Berlin. When the level of the ground-water is 
above the average, typhoid fever decreases ; when it is 
below the average, the number of cases becomes greater. 
It has been mathematically demonstrated that in Mu- 
nich the probability of the coincidence of a low stage 
of the ground-water with an increase of typhoid fever 
is in the ratio of 36,000 to 1. Hence, it may be re- 
garded as an established law that the rise and fall of 
the ground-water bears a definite relation to the mor- 
bility rate of typhoid fever. 



About twenty years ago Dr. Henry I. Bowditch, of 
Boston, called attention to the frequent connexion be- 
tween cases of pulmonary consumption and dampness 
of the soil upon which the patients lived. After a very 
extended and laborious investigation Dr. Bowditch 
formulated these two propositions : 

' First — A residence in or near a damp soil, whether 
that dampness be inherent in the soil itself or caused 
by percolation from adjacent ponds, rivers, meadows, 
or springy soils, is one of the principal causes of con- 
sumption in Massachusetts, probably in New England, 
and possibly other portions of the globe. 

' Second — Consumption can be checked in its career, 
and possibly — nay, probably — prevented in some in- 
stances by attention to this law. ' * 

Dr. Buchanan, of England, about the same time 
showed that the thorough drainage of certain English 
cities had markedly diminished the deaths from con- 
sumption in the drained cities. So far as the writer is 
aware not a single fact has been established which mil- 
itates against the law laid down by Dr. Bowditch and 
so strongly supported by the statistical researches of 
Dr. Buchanan, yet hardly any notice has been taken of 
these results by physicians. Few know anything of 
them and still fewer seem to have made practical use 
of such knowledge in advising patients. As corrobo- 
rative of the views of Dr. Bowditch the rarity of con- 
sumption in high and dry mountainous districts or 
plateaus may be cited. 

$ 

DISEASES OF ANIMALS PROBABLY DUE TO SIMILAR CON- 
DITIONS OF THE SOIL. 

The modern study of the sanitary relations of the 
soil is still in its infancy. Whatever definite knowl- 

* Consumption in New England and elsewhere. Second Edition, Boston, 1866, 
p. 67. 



100 TEXT-BOOK OF HYGIENE. 

edge has been gained relates merely to physical or 
chemical conditions of the soil and its atmosphere and 
moisture, or possibly the relations of these to the spread 
of certain diseases in human beings. But there is per- 
haps, a wider application that may be made of such 
knowledge than has been heretofore suggested. The 
domestic animals which form such a large portion of 
the wealth of this country — horses, cattle, sheep and 
hogs — are liable to infectious and contagious diseases, 
as well as are human beings, and many millions of dol- 
lars are lost annually by the ravages of such diseases. 
Now, from what is known of such diseases as splenic 
fever among cattle, and of the so-called swine-plague, 
it does not appear improbable to the writer that the 
source of infection is a soil polluted by the poisonous 
germ of these diseases, just as it seems demonstrated 
that cholera and typhoid fever, and possibly malarial 
fevers are so caused. The laborious investigations of M. 
Pasteur in France have shown that the cause of splenic- 
fever when once introduced into a locality will remain 
active for months and even years, and it seems probable 
that a study of the soil in its relations to the diseases of 
domestic animals is a subject to which attention may 
profitably be given. 

It is well-known that milch-cows frequently suffer 
from a disease identical in its nature with consumption 
in human beings. It is believed by many that the milk 
of such animals is not only unfit for food by reason of 
its poor quality, but that it may convey the disease to 
human beings when u%ed as food. The observations of 
Bowditch and Buchanan, quoted above, show that con- 
sumption in man may be, and doubtless is frequently 
caused by soil-wetness. It seems probable that the 
same cause should produce similar effects in the lower 
animals, and it is the writer's firm conviction that an 



SOIL. 101 

examination into the circumstances tinder which cows 
become attacked by consumption would prove this prob- 
ability a fact. 

DRAINAGE. 

In many soils drainage is necessary in order to 
secure a oonstant level of the ground-water at a suf- 
ficient depth below the surface. Drainage and sewer- 
age must not be confounded with each other. Drain- 
age contemplates only the removal of the ground-water, 
or the reduction of its level, while sewerage aims to 
remove the refuse from dwellings and manufactories, 
including excrementitious matters, waste water and 
other products, and in some cases the storm water. 

Sewers should never be used as drains, although 
for economy's sake, sewer and drainage pipes may be 
laid in the same trench. Sewer pipe must be perfectly 
air and water tight to prevent escape of its liquid or 
gaseous contents into the surrounding soil and render- 
ing it impure. Drainage pipe, on the other hand, 
should be porous and admit water freely from without. 
Escape of the contents of the drain pipe into the sur- 
rounding soil will not produce any pollution of the 
latter. 

The best material for drains is porous earthenware 
pipe, or the ordinary agricultural drain-tile. Coarse 
gravel, or broken stones may also be used, and prove 
efficient if the drains are properly constructed. Refer- 
ring again to the aphorism of Prof. De Chaumont, 
that a persistently low ground-water, say fifteen feet 
down, or more, is healthy ; that a persistently high 
ground-water, less than five feet from the surface is 
unhealthy ; and that a fluctuating level, especially if 
the changes are sudden and violent, is very unhealthy, 
the necessity appears obvious, that in the construction 
of drainage works, the drains should be placed at a 
sufficient depth to secure a level of the ground- Avater 



102 TEXT-BOOK OF HYGIENE. 

consistent with health. This depth should never be 
less than ten feet and if possible, not less than fifteen 
feet. Care must be taken that the outflow of the drain 
is unobstructed, in order that the soil may be kept 
properly dry at all times. 

In the absence of a proper mechanical system of 
drainage, the planting of certain trees may efficiently 
drain the soil. It has been found that the Eucalyptus 
tree has produced drying of the soil when planted in 
sufficient numbers in marshy land. The roots absorb 
a prodigious quantity of water which is then given off 
by evaporation from the leaves. Sunflower plants have 
a similar effect upon wet soils. 



CHAPTER V. 

REMOVAL OF SEWAGE. 

Iii all larger communities, certain arrangements 
are necessary to secure a prompt and efficient removal 
of excreta and the refuse and used water of house- 
holds and manufacturing establishments, the sweepings 
of streets, and rain water. 

The total quantity of excrementitious products, 
feces and urine, for each individual, including men, 
women and children, has been estimated by Dr. Parkes 
as two and a half ounces of fecal, and forty ounces of 
urinary discharge daily. This would give for a popu- 
lation of 1,000 persons, 25 tons of feces and 91,250 
gallons of urine per year. If to this is added a minimum 
allowance of thirty-five gallons of water per day to 
each individual, a complete sewerage system for a pop- 
ulation of 1,000 persons would require provision for the 
discharge of 35,279? gallons of sewage passing through 
the sewers every day. In this estimate, storm water, 
and such accessary feeders of the sewage are omitted. 

The organic matters contained in sewage, even if 
free from the specific germs of disease, give rise to 
noxious emanations, which, when inhaled, probably 
produce a gradual depravement of nutrition, that 
renders the system an easier prey to disease. For 
this, and other reasons, it is important that such 
measures be adopted as will secure the removal of 
sewage matters from the immediate vicinage of houses 
as quickly as possible after they have been discharged. 

The impregnation of the soil with sewage produces 
a contamination of ground-air and ground-water, 
which may become a source of grave danger to health. 
By polluting the ground-water, it eventually vitiates 



104 TEXT-BOOK OF HYGIENE. 

the well water which is nearly always derived from that 
source. 

The system of removal of excrementitious matters, 
which any community will adopt, depends to a consid- 
erable extent upon financial considerations. Although 
the sanitarian must insist upon the pre-eminent import- 
ance of the cause of public health, his suggestions 
will receive little attention from municipal or state 
legislatures unless they can be carried out without 
involving the community too deeply in debt. For this 
reason it is a matter of great practical importance that 
the student of sanitary science should make himself 
familiar with the relative cost as well as with the 
hygienic significance of the various methods of sewage 
removal in use. 

The different systems in use for the removal of 
sewage matters may be considered in detail under the 
following five heads : 

1. The common privy, or privy vault systems. 

2. The Rochdale or pail system, and its modifi- 
cations. 

3. The earth or ash closet system. 

4. The pneumatic system of Liernur. 

5. The water carriage systems. 

1. The Privy and Privy-well systems. — "While 
from a sanitary point of view, privies of all kinds, 
whether wells or cess-pits, are to be unreservedly con- 
demned, it is not likely that they will cease to be 
built for many years to come. It becomes necessary 
therefore, to point out by what means the objections 
against them may be diminished, and their evil conse- 
quences, in some measure averted. 

In the first place, a privy vault should be perfectly 
water-tight, in order to prevent pollution of the sur- 
rounding soil by transudation of the contained excre- 
mental matters. The walls should be of hard-btirned 



REMOVAL OF SEWAGE. 105 

brick, laid in cement. The cavity should be small in 
order that the contents may be frequently removed, 
and not allowed to remain and putrefy for months or 
years. A water-tight hogshead sunk in the ground 
makes an economical privy tank or receiver. A privy 
must not be dug in a cellar, or in too close proximity 
to the house-walls. Unless these last precautions are 
taken the offensive gases from the mass of decomposing 
fecal matter in the privy will constantly ascend into, 
and permeate the air of the house. 

All privies should be ventilated by a pipe passing 
from just under the privy seat to a height of some feet 
above the roof of the house. A gas flame, kept burning 
in the upper portion of this pipe will increase its ven- 
tilating power, by creating a strong and constant up- 
ward current. 

Disinfection of the contents of privies may be 
secured in a measure by means of sulphate of 
iron, carbolic acid, or dry earth. The first named is 
probably the most economical, most easily applied and 
most effective. A solution containing from one to two 
pounds of the salt in a gallon of water, is poured into 
the privy as often as necessary to prevent offensive 
odors. This solution may be conveniently prepared by 
suspending a basket or bag containing about 60 pounds 
of the sulphate in a barrel of water. In this way a 
saturated solution will be maintained until the salt has 
been entirely dissolved. 

The most rigid disinfection by chemicals will how- 
ever be less effective than thorough ventilation, for it 
must be remembered that the mere destruction of an 
offensive odor is not equivalent to removing all the 
deleterious properties that may be present. It is not 
at all certain that those elements of sewage which are 
the most offensive to the sense of smell are most detri- 
mental to health. 



106 TEXT-BOOK OF HYGIENE. 

Privies should be emptied of their contents at 
stated intervals. A strict supervision should be 
exercised over them by the municipal authorities in 
cities and towns to prevent overflowing of their con- 
tents. 

In many places the method of removing the 
contents of privies is the primitive one with shovel, or 
dipper and bucket. In most cities and large towns 
however, the privy vaults or tanks are now emptied by 
means of one of the so-called odorless excavating 
machines, of which there are a number of different 
patents. The process is rarely entirely odorless how- 
ever, as the carelessness of the workmen frequently 
permits offensive gases to escape and pollute the air for 
a considerable distance. All the different forms of the 
apparatus act upon the pneumatic principle. One end 
of a large tube is carried into the cess-pool or vault to 
be emptied, and the other attached to a pump, by means 
of which the material is pumped into a strong barrel- 
tank carried on wheels. At the top of the tank is a 
vent, over which is placed a small charcoal furnace to 
consume the foul gases escaping from the vent. 

In some cities, and many of the smaller towns and 
villages in this country, the primitive midden or pit 
system is still in use. A shallow pit is dug in the 
ground, over which is erected the privy. When the 
pit is full, another is dug close by the side of it, and 
the earth from the new pit thrown upon the excrement 
in the old one. The privy is then moved over the new 
pit and this is used until it too becomes full. The 
proceeding is repeated as often as the pit becomes filled 
up with the excreta, until in the course of a few years 
all the available space in a yard has been honey-combed 
with the pits. Then the custom adopted in over- 
crowded cemeteries is followed ; namely, the first pit is 
dug out again, and the cycle is repeated. 



REMOVAL OF SEWAGE. 107 

111 other cities the privy-well system is largely in 
use. This is — next to the midden or shallow pit just 
described — the most pernicious system for the disposal 
of excreta that can be imagined. The wells are dug to 
such a depth as to reach the subterranean how of water, 
in which the excremental matters are constantly 
carried off. Hence these receptacles never fill up, and 
never need cleaning. For this reason they are popular 
with property owners ; for next to the primitive midden 
they are the most economical of all the various 
methods adopted. The utter perniciousness of the 
system is however, plain, because the soil for a consid- 
erable distance around each of these wells becomes a 
mass of putrid filth, contaminating the ground-water 
which feeds the drinking water supplies in the 
vicinity ; polluting also the ground-air, which eventu- 
ally reaches the surface, or the interior of houses, when 
the pressure of the outside atmosphere diminishes, or 
the ground-water level rises. It must therefore be 
evident that the best ventilating arrangements, or the 
most thorough and consistent disinfection can have 
very little, if any, effect in removing the very grave 
objections to this baneful system. 

The privy-well system for the removal of excreta 
cannot be recommended for adoption by any sanitarian. 

2. Tlie Rochdale, or Pail-closet System. — The Roch- 
dale system of removal of excreta has won the support 
of many distinguished sanitarians, on account of its 
simplicity, its economy, and its compliance with most 
sanitary requirements. The excreta, both solid and 
liquid, are received into a water-tight pail, either of 
wood or metal, and removed once or oftener a week ; a 
clean and disinfected pail being substituted for the one 
removed. In Rochdale, Manchester and Glasgow in 
Great Britain, in Heidelberg in Germany, and in other 
cities abroad, where the system has been introduced, it 



108 TEXT-BOOK OF HYGIENE. 

has worked satisfactorily. In this country a modifica- 
tion of the pail system known as the Eagle Sanitary 
Closet, has been introduced by a firm in Charleston, 
S. C. The receptaele consists of an enameled iron 
reservoir, with a neck just large enough to fit under 
the seat of the privy, and a quantity of disinfectant 
solution is put into the receptacle, to prevent putrefac- 
tion of the excreta. The receptacles are replaced by 
clean ones every week. 

Mr. Jas. T. Gardner, Director of the N. Y. State 
Sanitary Survey, says in a special report on methods 
of sewerage applicable in small towns and villages, 
concerning the pail system :* 

'Rochdale is a city of some 70,000, and Manches- 
ter of between 400,000 and 500,000 inhabitants. The 
higher class of houses are allowed to have water-closets, 
but four-fifths of the people are obliged to have "pail 
closets ' ' in their yards built according to plans of the 
Health Department. Their essential features are : A 
flag-stone floor raised a few inches above the level of 
the yard ; a hinged seat with a metal rim underneath 
for directing urine into the pail, which stands on the 
flag directly beneath the seat ; a hinged front and back 
to the seat so that the pail or tub may be easily taken 
out and the place cleaned; and a six-inch ventilating 
pipe from under the seat to above the roof. In Roch- 
dale they use a wooden pail or tub made of half of a 
disused paraffine cask holding about 100 pounds ; in 
Manchester the "pail" is of galvanized iron and 
holds ten gallons. Under the direction of the author- 
ities they are removed once a week in covered vans, 
which bring clean tubs to be put in the place of the 
full ones taken away. Each tub is covered with a close 
fitting double lid before removal. The tubs are taken 
to a depot, where their contents are deodorised and pre- 

* Second Annual Report of New York State Board of Health, p. 3*;-3. 



REMOVAL OF SEWAGE. 100 

pared as manure by mixing with ashes and a small pro- 
portion of gypsum to fix the ammonia. Subsequently 
street sweepings and the refuse of slaughter-houses are 
acUied. At Manchester there is by the side of each 
closet a very simple ash sifter, from which the ashes 
fall into the tub and help to deodorise its contents. 

'The manure at Rochdale sells for about four-fifths 
of the cost of the collection and preparation. 

' In 1873 the net cost to the town of removing and 
disposing of the house dry refuse and excrement was 
only about $95 per annum per 1,000 of population; less 
than ten cents a person per annum. 

'The system has been in operation more than 
twelve years. 

'The tubs are removed in the day time without 
offensive odor. 

' Where ashes are frequently thrown into the tubs 
at Manchester, very little odor is to be perceived in the 
closets. 

'For the villages of the State which can have no 
general water supply, I would unhesitatingly advise 
the use of the "pail" or tub system as rjractised in 
Manchester, England, as being, from a sanitary point 
of view, an immense improvement over the death- 
breeding privy-vaults in common use. The cheapness 
of the plan and the smallness of the original outlay of 
brains and money, in comparison with that needed to 
build a good sewer system, will make it possible to in- 
troduce a tub-privy system into most villages half a 
century before sewers would meet with any considera- 
tion. 

'At a small cost the existing privy-vaults can be 
cleaned and filled, and the privies altered into healthful 
tub-closets. The town authorities must then arrange 
for the removal of the tubs once a week, and for their 
thorough cleansing and disinfecting. Any isolated 



110 TEXT-BOOK OF HYGIENE. 

house or group of houses can use the tub system, taking 
care of it themselves. If the plan is adopted in vil- 
lages, it will doubtless spread into the country, and 
become the most powerful means of abolishing the fatal 
privy- vaults which are poisoning the farm wells.' 

3. Earth and Ash Closets. — The earth and ash 
closets are devices in use to a large extent in England, 
and to a less degree in this country, for the purpose of 
rendering human excreta inodorous by covering them 
immediately after they are voided with dry earth or 
ashes. The earth-closet is the invention of the Rev. 
Henry Moule, of England, and consists of an ordinary 
commode or closet, the essential feature of which is a 
reservoir containing dried earth or ashes, a quantity 
of which, amounting to about twice the quantity of 
feces voided, is thrown upon the evacuation either by 
hand, or by means of an automatic apparatus called a 
'chucker.' Just as in the ordinary water-closet, by 
raising a handle a supply of water is thrown into the 
hopper to wash down the feces into the soil-pipe, so in 
the usual form of the earth-closet, raising the handle 
projects a quantity of earth upon the evacuated feces 
and urine. By this means the excreta are rendered 
entirely inodorous and dry. The contents of the closets 
may be collected into a heap in a dry place. In the 
course of a few months the organic constituents have 
become oxidised and the earth may be used over again, 
for a number of times. A well-known sanitarian states 
that he has used sifted anthracite coal ashes ten or 
twelve times over, in the course of three years. During 
this time the material under no circumstances gave any 
indication that it was 'anything but ashes, with 
a slight admixture of garden soil.'* 

Dr. Buchanan, of England, comparing the advan- 
tages of the earth-closet with those of the water-closet, 

* Waring ; The Sanitary Drainage of Houses and Towns, end Ed., 1881, p. 250. 



REMOVAL OF SEWAGE. Ill 

says : ' It is cheaper in original cost ; it requires 
less repairs; it is not injured by frost; it is not damaged 
by improper substances being thrown down it; and it 
very greatly reduces the quantity of water required by 
each household.'* 

In cities and towns, the removal of the excreta 
should be carried out by, or under the immediate di- 
rection of the municipal sanitary authorities. If this 
is neglected, abuses are liable to creep in which will 
vitiate the performance of any system however fault- 
less if properly managed. 

Many advocates of the pail, dry earth or privy- 
systems, urge the advantage of the large quantity of 
valuable manure which can be realised by converting 
the excremental matters into poudrette and other ferti- 
lising compounds. Experience has shown, however, 
that the cost of preparing a satisfactory fertiliser from 
human excrement is much greater than can be realised 
from its sale. In all places in Gfreat Britain and the 
continent of Europe where it has been tried, the decision 
is against its practicability. The agricultural consid- 
eration should, however, be a secondary one, if the 
systems mentioned are economical and meet the sani- 
tary requirements (which the privy-system certainly 
does not). The adoption of one, or other of them may 
be secured, where more perfect, but more complicated 
and expensive systems may be out of the question. 

4. The Pneumatic System of Liernur. — A system 
which seems to be useful in larger cities, especially 
where the topographical conditions are such as to 
render necessary mechanical aid in overcoming obsta- 
cles to natural drainage, is the pneumatic system 
devised by Capt. Liernur of Holland, and generally 
known as the Liernur system. It consists of a set of 
soil pipes running from the water-closets to central 

* Quoted in Waking, above cited, p; 264. 



112 TEXT-BOOK OF PIYGIENE. 

district reservoirs, from which the air is exhausted at 
stated intervals. When a vacuum is created in the 
reservoir the contents of the water-closets and soil 
pipes are driven forcibly into the reservoir by the 
pressure of air. The district reservoirs are connected 
by a separate system of pipes with a main depot and 
the transfer of the fecal matter from the former to 
the latter is also accomplished with the aid of pneu- 
matic pressure. The complete system of Liernur pro- 
vides that at the main depot, the fecal matter shall be 
treated with chemicals, evaporated, and converted into a 
dry fertiliser — poudrette. It appears from the pub- 
lished reports that while the system has been partially 
adopted in three Dutch cities, in only one of them, 
Dortrecht, has the machinery for manufacturing pou- 
drette been established. With reference to this, Eris- 
mann* says : ' It seems never to have been in regular 
working order, for the fecal masses are mixed with 
street-sweepings and ashes into a compost-mass, which 
causes no little discomfort in the neighborhood, by the 
offensive odors. In Amsterdam, the fecal matters. 
which frequently do not find a ready sale, are partly 
made into a compost with sweepings, partly used to 
fertilize meadows, or simply discharged into the water. 
As to the practical working of the system, the 
opinions differ widely. While the majority of sanita- 
rians including Virchow, von Pettenkofer, and Mr. 
Rawlinson, object to it as not fulfilling the demands of 
hygiene, the system has also been criticised by engineers 
as not being in accordance with the well-known prin- 
ciples of their science, f 

* Von Pettenkofer und Ziemssen. Handbuch der Hygiene. H Th. II Abth. 1 
Hlfte. p. 140. 

t Papers by Maj. C. H. Latrobe and Col. Geo. E. Waring, Jr.. in Fifth Bien- 
nial Report, Sid. State Board of Health. See also, in favor of system, a paper by 
Dr. C. W. Chancellor in same publication and an elaborate description by the same 
author in Trans. Med. and Chir. Faculty of Aid., 1883. 



REMOVAL OF SEWAGE. L13 

Two other plans for the removal of fecal matter 
by pneumatic pressure have been invented, namely the 
Shone and the Berlier systems. Neither of these has 
been adopted to any extent. Both seem to the author 
to fall far short even of the merits of the Liernur 
system. 

5. The Water- Carriage System of Sewerage. — Two 
systems of removal of sewage by water-carriage are in 
use at the present time. They are technically known 
as the 'combined' and the 'separate' systems. In the 
former, which is the system upon which most of the 
sewers in this country are constructed, all excreta, 
kitchen slops, waste water from baths and manufac- 
turing establishments, as well as storm water are 
carried off in the same conduits. In the separate sys- 
tem, on the other hand, the removal of the storm water 
is provided for, either by surface or underground drains, 
not connected with the sew T ers proper, in which only 
the discharge from water-closets and the refuse water 
from houses and factories are conveyed. In the sepa- 
rate system, the pipes are of such small calibre that a 
constant flow of their contents is maintained, prevent- 
ing deposition of suspended matters, and diminishing 
decomposition and the formation of sewer gas. 

In the combined system, on the other hand, the 
sewers must be made large enough to receive the maxi- 
mum rainfall of the district. This requires a calibre 
greatly in excess of the ordinary needs of the sewer, 
and furnishes favorable conditions for the formation of 
sewer gas, and the development of minute vegetable 
organisms. The ordinary flow in a sewer of large cali- 
bre is usually so sluggish as to promote the deposi- 
tion of solid matters and gradual obstruction of the 
sewer. 

It is the opinion of the most advanced sanitarians, 
that the separate system fulfils the demands of a 



114 TEXT-BOOK OF HYGIENE. 

rational system of sewerage better than any other at 
present in use. The objections to the combined system 
are so many and so great, that it does not seem advis- 
able for sanitary authorities to recommend the construc- 
tion of sewers on this principle in the future. 

The separate system of sewerage endorsed as it is 
by high engineering and sanitary authorities, and by a 
satisfactory, practical test of four years in the city of 
Memphis, seems to the author to possess merits above 
any other plan for the removal of excreta and house 
wastes. The following description is from a paper by 
Col. George E. Waring, Jr.: -A perfect system of 
sanitary sewerage would be something like the follow- 
ing : No sewer should be used of a smaller diameter 
than six inches : a, because it will not be safe to adopt a 
smaller size than four-inch for house drains, and the 
sewer must be large enough to surely remove whatever 
may be delivered by these: b, because a smaller pipe than 
six-inch would be less readily ventilated than is desira- 
ble : c, and because it is not necessary to adopt a 
smaller radius than three inches to secure a cleansing 
of the channel by reasonably copious flushing. 

' No sewer should be more than six inches in diam- 
eter until it and its branches have accumulated a suffi- 
cient flow at the hour of greatest use to till this size 
half full, because the use of a larger size would be 
wasteful, and because when a sufficient ventilating 
capacity is secured, as it is in the use of a six-inch 
pipe, the ventilation becomes less complete as the size 
increases — leaving a larger volume of contained air to 
be moved by the friction of the current, or by extra- 
neous influences, or to be acted upon by changes of 
temperature, and of volume of flow within the sewer. 

'The size should be increased gradually and only 
so rapidly as is made necessary by the tilling of the 
sewer half full at the hour of greatest flow. 



HEM OVA J. OF SEWAGKB. 115 

' Every point of the sewer should, by the use of 
gaskets or otherwise, be protected against the least 
intrusion of cement, which, in spite of the greatest 
care, creates a roughness that is liable to accumulate 
obstructions. 

'The upper end of each branch sewer should be 
provided with a Field's flush tank of sufficient capacity 
to secure the thorough daily cleansing of so much of 
the conduit as from its limited how is liable to deposit 
solid matters by the way. 

' There should be sufficient man-holes, covered by 
open gratings, to admit air for ventilation. If the di- 
rections already given are adhered to, man-holes will 
not be necessary for cleansing. The use of the Hush- 
tank will be a safeguard against deposit. With the 
system of ventilation about to be described, it will suf- 
fice to place the man-holes at intervals of not less than 
1,000 feet, 

' For the complete ventilation of the sewers it should 
be made compulsory for every householder to make his 
connexion without a trap, and to continue his soil-pipe 
above the roof of his house. That is, every house con- 
nexion should furnish an uninterrupted ventilation chan- 
nel four inches in diameter throughout its entire length. 
This is directly the reverse of the system of connexion 
that should be adopted in the case of storm-water and 
street- wash sewers. These are foul, and the volume of 
their contained air is too great to be thoroughly venti- 
lated by such appliances. Their atmosphere contains 
too much of the impure gases to make it prudent to 
discharge it through house-drains and soil-pipes. With 
the system of small pipes now described, the flushing 
would be so constant and complete, and the amount of 
ventilation furnished, as compared to volume of air to 
be changed, would be so great, that what is popularly 
known as "sewer-gas" would never exist in any part 



116 TEXT-BOOK OF HYGIEiVE. 

of the public drains. Even the gases produced in the 
traps and pipes of the house itself would be amply 
rectified, diluted, and removed by the constant move- 
ment of air through the latter. 

'All house connexions with the sewers should be 
through inlets entering in the direction of the flow, 
and these inlets should be funnel-shaped so that their 
flow may be delivered at the bottom of the sewer, and 
so that they may withdraw the air from its crown; that 
is, the vertical diameter of the inlet at its point of 
junction should be the same as the diameter of the 
sewer. 

'All changes of direction should be on gradual 
curves, and, as a matter of course, the fall from the 
head of each branch to the outlet should be continuous. 
Reduction of grade within this limit, if considerable, 
should always be gradual. 

'So far as circumstances will allow, the drains 
should be-brought together, and they should finally dis- 
charge through one or a few main outlets. 

'The outlet, if water-locked, should have ample 
means for the admission of fresh air. If open, the 
mouth should be protected against the direct action of 
the wind. 

' It will be seen that the system of sewerage here 
described is radically different from the usual practice. 
It is cleaner, is much more completely ventilated, and 
is more exactly suited to the work to be performed. 
It obviates the filthy accumulation of street manure in 
catch-basins and sewers, and it discharges all that is 
delivered to it at the point of ultimate outlet outside 
the town before decomposition can even begin. If 
the discharge is of domestic sewage only, its solid mat- 
ter will be consumed by fishes if it is delivered into a 
water-course, and its dissolved material will be taken 
up by aquatic vegetation. 



REMOVAL OF SEWAGE. 117 

' The limited quantity and the uniform volume of 
the sewage, together with the absence of dilution by 
rain-fall, will make its disposal by agricultural or 
chemical processes easy and reliable. 

'The cost of construction, as compared with that 
of the most restricted storm-water sewers, will be so 
small as to bring the'improvement within the reach of 
the smaller communities. 

'In other words, while the system is the best for 
large cities, it is the only one that can be afforded in 
the case of small towns. 

'Circumstances are occasionally such as to require 
extensive engineering works for the removal of storm- 
water through very deep channels. Ordinarily, the 
removal of storm- water is a very simple matter, if we 
will accept the fact that it is best carried, so far as 
possible, by surface gutters, or, in certain cases by 
special conduits, placed near the surface. 

'It is often necessary, in addition to the removal 
of house waste, to provide for the drainage of the sub- 
soil. This should not be effected by open joints in the 
sewers; because tie same opening that admits soil- 
water may, in dry seasons, and porous soils, permit 
the escape of sewage matters into the ground, which is 
always objectionable. 

' Soil- water drains may be laid in the same trench 
with the sewers, but preferably, unless they have an 
independent outlet, on a shelf at a higher level. When 
they discharge into the sewer, they should always de- 
liver into its uppper part, or into a man-hole at a point 
above the flow-line of the sewage.'* 

The establishment of a system of sewerage pre- 
supposes a constant and abundant supply of water to 
keep all closets clean, and all house-drains and street 
sewers well flushed. Where this cannot be obtained, 

* Waring : The Sewering and Drainage of Cities. Public Health, Vol. V., p. 35. 



118 TEXT-BOOK OF HYGIENE. 

sewers would be likely to prove greater evils than ben- 
efits. In such cases one of the methods of removal of 
excreta above mentioned, either the pail or earth-closet 
system should be adopted. 

The final disposal of sewage is a problem that de- 
pends for its solution partly upon the agricultural 
needs of the country around the city to be sewered,, 
partly upon the proximity of large bodies of water or 
running streams. When the city is situated upon, or 
near large and swiftly flowing streams, the sewage 
may be emptied directly into the stream without se- 
riously impairing the purity of the latter. Dilution, 
deposition and oxidation will soon remove all appre- 
ciable traces of the sewage of even the largest cities. 
Where, on the other hand, the stream is inadequate in 
size to carry off the sewage, or where, as in the Seine 
and Thames, the current is sluggish, some other method 
of final disposal must be adopted. 

In many cities of Great Britain and the continent 
of Europe the disposal of the sewage by irrigation of 
cultivated land has been practised for a number of 
years. The reports upon the working of the system are 
generally favorable, although some sanitarians express 
doubts of the efficiency of the system. In using sewage 
for the irrigation of land, two objects are secured, first, 
the fertilisation of the land by the manurial constitu- 
ents of the sewage, and second, the purification of the 
liquid portion by filtration through the soil. The or- 
ganic matters which have been held back by the soil 
undergo rapid oxidation in the presence of air and the 
bacteria of decay, and are converted into plant-food, 
or into harmless compounds. 

Sewage irrigation as practised in Europe, must 
make provision for the disposal of a very large proportion 
of water in the sewage (street-wash, storm-water) which 
requires much larger areas of land than would be needed if 



REMOVAL OF SEWAGE. 110 

only sewage material proper (water-closet and kitchen 
waste) was to be thus disposed of. In this country a 
practical experiment has recently been made with a 
well constructed separate system of sewerage, deliver- 
ing only the sewage materials above mentioned upon 
the irrigation area.''- The success of the experiment is 
said to be exceedingly satisfactory. 

All land -used for sewage irrigation should be 
drained with drain tile at a depth of three to six feet 
below the surface, in order to promote a rapid carry- 
ing off of the watery portion of the sewage, purified by 
filtration through the soil. A sandy loam is the best 
soil for irrigation. Clay is not sufficiently permeable 
to air and water, while pure sand allows the sewage to 
pass through too readily, before the organic matters in 
it have been sufficiently oxidised. 

It has been shown that the roots of plants' assist 
largely in the oxidation of organic matter. 

The entire process of collecting and finally dispos- 
ing of sewage matters from the moment they are 
received in the house receptacles until discharged into 
the swiftly flowing stream or on the sewage farm, should 
be void of offense to the senses of sight or smell. 
With a proper construction and management of sewer- 
age works, on the lines indicated in this chapter, it is 
believed these results can be attained. 

[ The following works give fuller details upon the 
matters treated in the two foregoing chapters : 

Eeismann : Entfernung der Abf'allstoffe. Hdbcb d. Hygiene, etc. II Th. 
I. Abth. I. Hlfte. C. F. Folsom. The Disposal of Sewage, Seventh Rep't 
Mass. State Board of Health , 1876, p. 276. Soyka : Stadte-reinigung, in 
Realencyclopaedie d. ges. Heilk. Bd. XIII., p. 14, et. seq. W. H. Fokd. 
Soil and Water, in Buck's Hygiene and Public Health, Vol. I. Pettenko- 
fer : The Sanitary Relations of the Soil. Pop. Sci. Monthly, Vol, XX, p- 
332, 468.] 

* Pullman from a State Medicine Point of View. By O. C. De Wolf, AC. T). Pub- 
lic Health, Vol. IX., p. 290. 



CHAPTER VI. 

CONSTRUCTION OF HABITATIONS. 

The importance of observing the principles of 
hygiene in the construction of habitations for human 
beings is not sufficiently appreciated by the public. 
Architects and builders themselves have not kept pace 
with the sanitarian, in the study of the conditions 
necessary to be observed in building a dwelling house 
which shall answer the requirements of sanitary science. 

In an investigation conducted by Dr. Villerme* 
it was found that in France, from 1821-1827, of the 
inhabitants of arrondissements containing 7 per cent. 
of badly constructed dwellings, one person out of every 
seventy-two died. Of inhabitants of arrondissements 
containing 22 per cent, of badly constructed dwellings, 
one out of sixty-five died, while of the inhabitants of 
arrondissements containing 38 per cent, of badly con- 
structed dwellings, one out of every forty-five died. 

Inseparable from the question of the defective con- 
struction of dwellings, is that of overcrowding in cities, 
because the most crowded portions of a city are at the 
same time those in which the construction of dwellings 
is most defective from a hygienic standpoint. The 
following tables show the relations of the death-rate to 
density of population in various large cities of Europe; 
and also the relations between overcrowding in dwell- 
ings and the mortality from contagious diseases : 

Relation of Death-rate to Density of Population. 

XEAN NUMBER OF AVERAGE DEATH-RATE 

CITT. INHABITANTS PER 1.000 

TO EACn HOVSE. INHABITANTS. 

London, ... 8 24 

Berlin, - ... 32 25 

Paris, - 35 2S 

St. Petersburg, - - - 52 41 

Vienna 55 47 

* Quoted in Reatencyclopsedia d. ges. Heilk. Bd. II., 71. 



CONSTRUCTION OF HABITATIONS. 121 

In Berlin in 1872-3 it was found that out of every 
one hundred deaths from al] causes, there were from 
contagious diseases : 

20 Deaths in Dwellings with 1-2 Persons in each Room. 

2U " " " " " 3-5 

32 " " " " 6-10 " " " 

79 " " " with over 10 " " " 

These figures show very clearly the vital importance 
of the application of sanitary laws in the construction 
of dwellings. 

Another curious and suggestive point is presented 
by some statistical researches on the mortality of Ber- 
lin, in regard to the death-rate among persons living in 
different stories of houses. It was found, for example, 
that the mortality in fourth-story dwellings is higher 
than in the lower stories. Even basement-dwellings 
furnish a lower death-rate. Still-births especially, oc- 
cur in a larger proportion among the occupants of the 
upper stories of houses. 

It is in the death-rate among young children, that 
the effects of overcrowding and unsanitary construc- 
tion of dwellings, are especially manifest. The mor- 
tality returns from all the large cities of the world 
give mournful evidences of this every summer. 

The researches of Dr. H. I. Bowditch upon soil- 
wetness, to which reference has already been made in 
a previous chapter, show conclusively that persons 
living in houses situated upon or near land habitually 
or excessively wet, are especially prone to be attacked 
by pulmonary consumption. Dr. Buchanan* has cor- 
roborated the truth of Dr. Bowditch' s observations by 
showing from the records of a number of cities and 
towns of Great Britain that with the introduction of a 
good drainage system, bringing about a depression and 
uniformity of level of the ground-water, the mortality 
from consumption and other diseases very markedly 

* Ninth and Tenth Reports of the Medical Officer to the Privy Council. 



122 TEXT-BOOK OF HYGIENE. 

diminished. The following table showing the propor- 
tionate amount of this diminution, is abridged from 
the official reports:* 

Results of Sanitary Work. 







AVERAGE 


AVERAGE 




REDUCTION 


REDTCTION 


NAME 




MORTALITY 


MORTALITY 


SAVING 


OF 


IN 


OP 


IN 


PER 1,000 


PER 1,000 


OF 


TYPHOID 


RATE 


PLACE. 


1861. 


BEFORE 


SINCE 


LIFE. 


FEVER 


OF 






CONSTRUCTION 


COMPLETION 


PER CT. 


RATE. 


PHTHISIS. 






OF WORKS. 


OF WORKS. 




PER CT. 


PER CT. 


Banbury, 


10,238 


23.4 


20.5 


12* 


48 


41 


Cardiff, - 


32,954 


33.2 


22.6 


32" 


40 


17 


Croydon, 


30,229 


23.7 


18.6 


22 


63 


17 


Dover, 


23,108 


22.6 


20.9 


7 


36 


20 


Ely, - 


7,84? 


83.9 


20.5 


14 


56 


47 


Leicester, - 


68,056 


26.4 


25.2 


44 


48 


32 


Macclesfield, 


27,475 


29.8 


23.7 


20 


48 


31 


Menhyr, - 


52,778 


33 2 


26.2 


18 


60 


11 


Newport, 


24,756 


31.8 


21.6 


32 


36 


32 


Rugby, - 


7,818 


19.1 


18.6 


2* 


10 


43 


Salisbury, - 


9,030 


27.5 


21.9 


20 


75 


49 


Warwick, - 


10,570 


22.7 


21.0 


7i 


52 


19 



The following points must be taken into account in 
building a house in accordance with sanitary principles : 



The building site should be protected against vio- 
lent winds, although a free circulation of air all around 
the house must be secured. Close proximity to ceme- 
teries, marshes, and injurious manufacturing establish- 
ments, or industries, must be avoided, if possible. A 
requisite of the highest importance is the ability to 
command an abundant supply of pure water for drink- 
ing, and other purposes. A neglect of this precaution 
will be sure to result to the serious inconvenience, if 
not detriment of the occupants of the house. 

II. — CHARACTER OF THE SOIL. 

The soil should be porous and free from decom- 
posing animal or vegetable remains, or excreta of man 
or animals. It should be freely permeable to air and 
water, and the highest level of the ground-water should 
never approach nearer than ten feet to the surface. 

* Baldwin Latham : Sanitary Engineering. Chicago, 1S7T, p 8. 



CONSTRUCTION <>F HABITATIONS. 123 

The fluctuations of the ground-water level should be 
limited. In this connexion, attention is again called 
to the aphorism of Dr. De Chaumont.* 

It is impossible to say positively that any kind of 
soil is either healthy or unhealthy, merely from a 
knowledge of its geological characters. The accidental 
modifying conditions above referred to, viz: organic 
impurities, moisture, the level and fluctuations of the 
ground- water are of much greater importance than 
mere geological formation. The late Dr. Parkes, how- 
ever, regarded the geological structure and conforma- 
tion as of no little importance, and summarized the 
sanitary relations of soils variously constituted, as 
follows :f 

'1. Tlie Granitic,, MetamorpJiic, and Trap Mocks. — 
Sites on these formations are usually healthy; the slope 
is great, water runs off readily; the air is compara- 
tively dry; vegetation is not excessive; marshes and 
malaria are comparatively infrequent, and few impuri- 
ties pass into the drinking water. 

' AVhen these rocks have been weathered and disin- 
tegrated, they are supposed to be unhealthy. Such soil 
is absorbent of water; and the disintegrated granite of 
Hong Kong is said to be rapidly permeated by a fun- 
gus; but evidence as to the effect of disintegrated gran- 
ite or trap is really wanting. 

' In Brazil the syenite becomes coated with a dark 
substance, and looks like plumbago, and the Indians 
believe this gives rise to "calentura," or fevers. The 
dark granitoid, or metamorphic trap, or hornblendic 
rocks in Mysore, are also said to cause periodic fevers; 
and iron hornblende especially Avas affirmed by Dr. 
Heyne, of Madras, to be dangerous in this respect. 
But the observations of Klchter on similar rocks in 

* Chapter IV., p. 97'. 

t Practical Hygiene, 6th Ed.. Vol. I., p. 339. 



124 TEXT-BOOK OF HYGIENE. 

Saxony, and the fact that stations on the lower spurs 
of the Himalayas on such rocks are quite healthy, neg- 
ative Heyne's opinion. 

'2. The Clay Slate. — These rocks precisely resem- 
ble the granite and granitoid formations in their effect 
on health. They have usually much slope; are very 
impermeable; vegetation is scanty, and nothing is added 
to air or drinking-water. 

' They are consequently healthy. Water, however, 
is often scarce, and as to the granite districts, there 
are swollen brooks during rain, and dry water courses 
at other times swelling rapidly after rains. 

'3. The Limestone, and Magnesian Limestone 
Roclcs. — These so far resemble the former, that there is 
a good deal of slope, and rapid passing off of water. 
Marshes, however, are more common, and may exist at 
great heights. In that case, the marsh is probably fed 
with water from some of the large cavities, which, in 
the course of ages become hollowed out in the limestone 
rocks by the carbonic acid in the rain, and form reser- 
voirs of water. 

'The drinking water is hard, sparkling and clear. 
Of the various kinds of limestone, the hard oolite is 
best, and magnesian is worst; and it is desirable not to 
put stations on magnesian limestone if it can be avoided. 

' 4. The Clialk. — The chalk, when mixed with clay, 
and permeable, forms a very healthy soil. The air is 
pure, and the water, though charged with calcium car- 
bonate, is clear, sparkling, and pleasant. Goitre is not 
nearly so common, nor apparently calculus, as in the 
limestone districts. 

'If the chalk be marly, it becomes impermeable, 
and is then often damp and cold. The lower parts of 
the chalk which are underlaid bygault clay, and which 
also receive the drainage of the parts above, are often 



CONSTRUCTION OF HABITATIONS. 12f> 

very malarious; and in America, some of the most 
marshy districts are in the chalk. 

'5. The Sandstones. — The permeable sandstones 
are very healthy; both soil and air are dry; the drink- 
ins,- water is. however, sometimes impure. If the sand 
be mixed with much clay, or if clay underlies a shallow 
sand-rock, the site is sometimes damp. 

'The hard millstone grit formations are very 
healthy, and their conditions resemble those of granite. 

' 6. Gravels of any depth are always healthy, except 
when they are much below the general surface, and 
water rises through them. Gravel hillocks are the 
healthiest of all sites, and the Avater, which often flows 
out in springs near the base, being held up by the un- 
derlying clay, is very pure. 

'7. Sands. — There are both healthy and unhealthy 
sands. The healthy are the pure sands, which contain 
no organic matter, and are of considerable depth. The 
air is pure, and so is often the drinking-water. Some- 
times the drinking-water contains enough iron to be- 
come hard, and even chalybeate. The unhealthy sands 
are those which, like the subsoil of the Landes, in 
southwest France, are composed of silicious particles 
(and some iron), held together by a vegetable sediment. 

'In other cases sand is unhealthy, from underlying 
clay or laterite near the surface, or from being so placed 
that water rises through its permeable soil from higher 
levels. Water may then be found within three or four 
feet of the surface; and in this case the sand is un- 
healthy, and often malarious. Impurities are retained 
in it, and effluvia traverse it. 

' In a third class of cases, the sands are unhealthy be- 
cause they contain soluble mineral matter. Many sands 
(as, for example, in the Punjab) contain magnesium car- 
bonate and lime salts, as well as salts of the alkalies. 
The drinking-water may thus contain large quantities 



126* TEXT-BOOK OF HYGIENE. 

of sodium ' chloride, sodium carbonate, and even lime 
and magnesian salts and iron. Witliout examination 
of the water, it is impossible to detect these points. 

'8. Clay, Dense Marls, and Alluvial Soils gener- 
ally. — These are always regarded with suspicion. 
Water neither runs off nor runs through: the air is 
moist; marshes are common; the composition of the 
Avater varies, but it is often impure with lime and soda 
salts. In alluvial soils there are often alterations of 
thin strata of sand, and sandy, impermeable clay. 
Much vegetable matter is often mixed with this, and 
air and water are both impure. 

The deltas of great rivers present these alluvial 
characters in the highest degree, and should not be 
chosen for sites. If they must be taken, only the most 
thorough drainage can make them healthy. It is 
astonishing, however, what good can be effected by 
the drainage of even a small area, quite insufficient to 
affect the general atmosphere of the place ; this shows 
that it is the local dampness and the effluvia which are 
the most hurtful. 

'9. Cultivated Soils. — Well-cultivated soils are 
often healthy, nor at present has it been proved that 
the use of manure is hurtful. Irrigated lands, and 
especially rice fields, which not only give a great surface 
for evaporation, but also send up organic matter into 
the air, are hurtful. In Northern Italy, where there 
is a very perfect system of irrigation, the rice grounds 
are ordered to be kept 14 kilometers (8.7 miles) from 
the chief cities. 9 kilometers (5.6 miles') from the lesser 
cities and the forts, and 1 kilometer (1.094 yards) from 
the smaller towns. In the rice countries of India (and 
America), this point should not be overlooked." 

Where a wet, impermeable, or impure soil must. 
of necessity, be chosen as a building site, it should be 
thoroughly drained. The minimum depth at which 



CONSTRICTION OF HABITATIONS. 127 

drains are laid should be not less than five feet below 
the floor of the cellar or basement. Such a soil should 
be covered with a thick impervious layer of asphaltum 
or similar cement under the house, in order to prevent 
the aspiration of the polluted ground-air into the 
building. 

It is a frequent custom in cities to fill in irregular- 
ities of the building-site with street-sweepings, and 
garbage, which always contain large quantities of de- 
composing organic matters. This is a gross violation 
of the plainest principles of hygiene. It is almost 
equally reprehensible to use such decaying or putrefy- 
ing organic material for the purpose of grading streets 
or sidewalks in cities and towns.* It should be the 
constant endeavor of all sanitary authorities to prevent 
pollution of the soil as much as possible in villages, 
towns and cities. 

Where houses are built on the declivity of a hill, 
the upper wall should not be built directly against the 
ground, as it would tend to keep the wall damp. A 
vacant space should be left between the wall and the 
ground to permit free access of air and light. 

In addition to, or in default of drainage, the dry- 
ing of soil can be promoted by rapidly growing plants, 
which absorb water from the soil and give it out to the 
air. The sunflower and the eucalyptus tree are the 
most available for this purpose. 

III. — THE MATERIAL OF WHICH THE HOUSE IS BUILT. 

The nature of the most appropriate building material 
depends upon so many collateral circumstances, that 

* During the very fatal epidemic of yellow fever in New Orleans in 1878, it was 
ascertained that a contractor for street-work used the garbage and street-scrapings 
to grade the bed of the streets. Even though in this case it may not have intensified 
the epidemic in these localities, the practice is so contrary to the simplest sanitary 
laws, that it should nowhere be tolerated. The author is aware, however, that the 
'made ground' of nearly every city in this country is composed largely of just such 
material. All sanitarians should protest against a continuance of this pernicious 
practice. 



128 TEXT-BOOK OF JIYOTKXE. 

definite rules cannot be laid down. As a general rule, 
moderately liard-burned brick is the most serviceable 
and available material. It is easily permeable by the 
air, and so permits natural ventilation through the 
walls, unless this is prevented by other means. It does 
not absorb and hold water readily, hence, damp walls 
are infrequent, if brick is used. It is probably of all 
building material the most durable. On account of its 
porosity, a brick wall is a poor conductor of heat. It 
therefore prevents the rapid cooling of a room in cold 
weather, and likewise retards the heating of the inside 
air from without, in summer. Another very great 
advantage, is its resistance to a very high degree of 
heat, brick being probably more nearly fire-proof, than 
any other building material. 

In hot climates, light wooden buildings are advan- 
tageous, because they cool off very rapidly after the 
sun has disappeared. On account of the numerous 
joints and fissures in a frame building, natural ventila- 
tion goes on very readily and to a considerable extent. 

Next to brick, granite, marble and sandstone are 
the most serviceable building materials. Very porous 
sandstone is, however, not very durable in cold climates, 
as the stone absorbs large quantities of water, which 
in consequence of the expansion accompanying the act 
of freezing, produces a gradual but progressive disin- 
tegration. 

The application of paint to the walls, either within 
or without, almost completely checks the transpiration 
of air through the walls, thus limiting natural ventila- 
tion. Calcimining, on the other hand, offers very 
little obstruction to the passage of air. Wall-paper is 
about mid- way between paint and lime coating in its 
obstructive effect on atmospheric transpiration. 

Newly-built houses should not be occupied until 
the walls have become dry. Moisture in the walls is 



CONSTBUOTION OF HABITATIONS. 12!) 

probably a not infrequent source of ill-health ; it offers 
favorable conditions for the development of fungi 
( possibly of disease-germs ), and, by filling up the pores 
of the material of which the walls are composed, pre- 
vents the free transpiration of air through them. 

Moisture of the walls is sometimes due to ascent 
of the water from the soil by capillary attraction. 
This can be prevented by interposing an impervious 
layer of slate in the foundation wall. 

Where the moisture is due to the rain beating 
against the outside walls and thus saturating them if 
composed of porous materials, a thorough external 
coating of impervious paint will prove a good remedy. 

IV. INTERIOR ARRANGEMENTS. 

A. Size of Rooms, and Ventilating and Heating 
Arrangements. — The rooms in dwelling-houses should 
never be under eight feet in height from floor to ceiling. 
In sleeping rooms, the initial air-space should never be 
less than 1,200 cubic feet for adults, and 800-900 cubic 
feet for children under ten years of age. Provision 
must be made for changing this air sufficiently often to 
maintain it at its standard of purity ; i. e. , less than 
seven parts of carbonic acid per 10,000. The details 
for accomplishing this will vary with the architects' 
designs, the material of which the house is constructed, 
the climate, and the season. The principles laid down 
in the section on ventilation, (Chap. I) should be 
adhered to. In cold weather, the air should be warmed 
either before its entrance into the room, or afterward 
by stove or fireplace. The details of the heating appa- 
ratus must be left to individual taste, or other circum- 
stances. It may be noted, however, in passing, that 
the prevailing method of heating houses by means of 
hot air is objectionable for various reasons ; partly, 
because the air is usually too dry to be comfortable to 



130 TEXT-BOOK OF HYGIENE. 

the respiratory organs ; partly, because organic matter 
is frequently present in large proportions, and gives 
the air an offensive odor when the degree of heat is 
high enough to scorch the organic matter. Both these 
objections are however, removable ; the first by keeping 
a vessel of water constantly in the furnace, so that the 
hot air can take up a sufficient proportion of vapor in 
passing through, and the second by having the furnace 
made large enough so that the temperature need never 
be raised to a very high degree. 

B. Internal Wall Coating. — A point of consider- 
able importance in the out-fitting of* dwelling-houses is 
the material used for coating or decorating the inside 
of the walls. Green paint, or green-colored wall papers 
should be rejected. The reason for avoiding this color 
is the following. Bright-green pigments and dyes are 
largely composed of some compound of arsenic, which 
becomes detached from the wall or paper when dry, 
and being inhaled produces a train of symptoms, which 
have been recognized as chronic arsenical poisoning. 
Many cases have been reported in which serious and 
even fatal poisoning has been produced in this way.* 
It would be advisable, therefore, to discard all bright- 
green tints in paints and ornamental paper hangings. 

C. Lighting. — Provision sliould be made, in all 
dwelling-houses for an abundant supply of sun-light. ■ 
Every room should have at least one window opening 
directly to the sun. It is not sufficient to give an 
ample window-space, which should be in the proportion 
of one to five or six of floor space, but the immediate 
surroundings of the house must be taken into account. 
Thus, close proximity of other buildings, or of trees 
may prevent sufficient light entering a room, although 
the window-space may be in excess of that required 
under ordinary circumstances. 

* F. W Draper : Arsenic in Certain inretL Culors. Third Annual BeptXue 
State Board of Health, 1878. p. 18-OT. 






COjSTSTBUCTION OF HABITATIONS. 131 

Some form of artificial light will also be needed in 
all dwellings. Certain dangers are necessary accom- 
paniments of all available methods of artificial illumi- 
nation. The danger from tire, is, of course, the most 
serious. This danger is probably least where candles 
are used, and greatest where the more volatile oils 
( kerosene, gasoline, ) are employed. The use of candles 
results in pollution of the air by carbonic acid and other 
products of combustion to a greater degree than when 
other illuminating agents are used; they also give out a 
larger amount of heat in proportion to their power of illu- 
mination. Kerosene gives a good light, when burned in 
a proper lamp, and is cheap, but the dangers from 
explosion and fire are considerable. The danger from 
explosion can be greatly reduced by always keeping 
the lamp filled nearly to the top, and never filling it 
near a light or tire. The danger of explosion is in- 
creased when the chimney of the lamp is broken, as 
then the temperature of the metal collar by which the 
burner is fastened to the lamp is rapidly raised, * and 
the oil vaporized. If at the same time the lamp is only 
partially filled with oil, the space above it is occupied 
by an explosive mixture of air and the vapor of the 
oil. If this is heated to a sufficient degree, an explosion 
will take place, f 

The use of coal-gas is probably attended by less 
danger than the lighter oils, but by more than other 
means of illumination. In addition to the dangers 
from tire and explosions, which are inevitable accompa- 
niments of defects in the fixtures, the escaping gas is 
itself exceedingly poisonous from the large amount of 
carbonic oxide it contains. It is, in fact, a very frequent 
occurrence, in large cities, that persons are killed by 

* H. B. Baker, in Kep't Mich. State Board of Health. 1376. p. XLVIII. 
t See an instructive paper by Prof. R. C. Kedzib in Bep't Mich. State Board of 
Health for 18T7. p. 71, et. seq. 



132 TEXT-BOOK OF HYGIEXE. 

the inhalation of gas which has escaped from the fix- 
tures, or was allowed to escape from the burner, through 
ignorance. 

The electric light (Edison's incandescent system) is 
probably open to less objection on the score of danger, 
than any other of the illuminating systems mentioned. 
There is no reliable evidence that the electric light has 
any unfavorable influence on the vision, although Reg- 
nault supposed it would have a bad effect upon the 
ocular humors, on account of the large proportion of 
the violet and ultra-violet rays it contained. In order 
to remove this objection, Bouchardat advised the wear- 
ing of yellow glasses by those compelled to use this 
light for close work. The advantages of The incandes- 
cent light, beside the brilliant white light it gives, are 
that it is steady, and does not produce any heat, nor 
does it pollute the air with carbonic acid and other 
products of combustion. Prof, tor Pettenkofer has 
recently shown experimentally that the pollution of 
the air by the products of combustion is very much 
greater when gas is used than where the electric light 
is employed. 

In writing, sewing, reading or other work requir- 
ing a constant use of accurate vision, the light, whether 
natural or artificial, should fall upon the object from 
above and on the left side. Hence, windows and bur- 
ners should be. at least, at the height of the shoulder 
and to the left of the person using the light. 

Increased ventilation facilities must be provided 
where artificial light (except the electric light) is used 
to any extent. It has been calculated that for every 
lighted gas-burner, 400-500 cubic feet of fresh air per 
hour must be furnished in addition to the amount or- 
dinarily required, in order to maintain the air of the 
room at the standard of purity. 



CONSTRUCTION OF HABITATIONS. 133 

V. — WATER SUPPLY. 

The water supply of a dwelling house should be 
plentiful for all requirements, and its distribution 
should be so arranged that the supply for every room 
is easily accessible. Where practicable, water taps 
should be placed on every floor, both for convenience, 
and for greater safety in case of fire. It is also a result 
of observation that personal habits of cleanliness in- 
crease in a direct ratio with the ease of obtaining the 
cleansing agent. The inmates of a house where water 
is obtainable with little exertion, are much more likely 
to be cleanly in habits, than where the water supply is 
deficient, or not readily procured. 

VI. — HOUSE DRAINAGE. 

Provision must be made for the rapid and thorough 
removal of waste water and excrementitious substances 
from the house. This is most easily and completely 
accomplished by Avell-constructed water-closets and 
sinks. Water-closets should, however, not be tolerated 
in any room occupied as a living or bed-room. It would 
doubtless be very much more in accordance with sani- 
tary requirements to have all permanent water-fixtures, 
water-closets and bathing arrangements placed in an 
annex to the dwelling proper. In this way, the most 
serious danger from water-closets and all arrangements 
having a connexion Avith a cess-pool, or common sewer 
— permeation of the house by sewer-air — could be 
avoided. 

Water-closets, however, presuppose an abundant 
supply of water. Unless this can be obtained and 
rendered available for flushing the closets, soil-pipe 
and house-drain, the dry-earth or pail system should 
be adopted. Privies should not be countenanced. Ex- 
perience in several large cities of Europe has demon- 



134 TEXT-BOOK OF HYGIEXE. 

strated* that the pail system can be adopted with ad- 
vantage, and satisfactorily managed even in large com- 
munities. 

As house drainage may be considered the first 
and most important link in a good sewerage system, a 
brief description will be, here given of the details of 
the drainage arrangements of a dwelling house. The 
rapid and complete removal of all fecal and urinary dis- 
charges, lavatory and bath-wastes and kitchen slops 
must be provided for. For these purposes are needed, 
first, water-closets and urinals, wash-basins and bath- 
tubs, and kitchen or slop-sinks; second; a perpendicu- 
lar pipe, with which the foregoing are connected, termed 
the soil-pipe, and third, a horizontal pipe or house- 
drain, connecting with the common cess-pool or sewer. 

A. Water-Closets. — There are five classes of water- 
closets in general use. They are the pan. valve, plun- 
ger, hopper and washout closets. 

Pan closets are those found in most old houses con- 
taining water-closet fixtures. Just under the bowl of 
the closet is a shallow pan containing a little water, in 
which the dejections are received. On raising the han- 
dle of the closet, the pan is tilted, and the water at the 
same time is turned on. which washes out the excre- 
ment and sends it into or through the trap between the 
closet and the soil-pipe. It will be readily understood 
that the space required for the movement of the pan, 
the 'container' as it is termed, is rarely thoroughly 
cleansed by the passage of water through it. Fecal 
matter, paper, etc.. gradually accumulates in the cor- 
ners of the container, and as a consequence, pan closets 
are always, after a brief period of use, foul. There are 
other defects in the construction of the pan closet, 
which renders it untrustworthy, but the one especially 
pointed out — the impossibility of keeping it clean — is 



CONSTBUOTION OF HABITATIONS. 135 

enough to absolutely condemn its use, from a sanitary 
point of view. It is decidedly the worst form of closet 
that can be used. 

Yalve closets are merely modifications of the pan 
closet. The bottom of the bowl is closed by a flat 
valve, which is held in its place by a weight. By 
moving a lever the valve is turned down allowing the 
excreta to drop into the container. The only differences 
between the pan and valve closets are that in the latter 
a flat valve is substituted for the pan of the former, 
and that this allows the container to be made smaller. 
Otherwise, there are no advantages in the valve closet. 
Considered from a sanitary standpoint, the valve closet 
is no worse than the pan closet, and but very little, if 
any, better. 

The third variety, or plunger closet, has several 
marked advantages over the two just described. The 
characteristic feature of the closets of this class is that 
the outlet, which is generally on one side of the bowl, 
is closed by a plunger. This bowl is always from one- 
third to half full of water, into which the excreta fall. 
On raising the plunger, the entire contents of the bowl 
are rapidly swept out of the apparatus into the soil- 
pipe, the bowl thoroughly washed out by a sudden dis- 
charge of water, and on closing the outlet with the 
plunger, the bowl is again partly filled with water. 
An overflow attachment prevents accumulation of too 
large a quantity of water in the bowl. The Jennings, 
Demarest, and Hygeia, are types of this class. The 
principal objection is that the plunger sometimes fails 
to properly close the outlet, allowing the water to drain 
out of the bowl, and thus destroying one of ' its prin- 
cipal advantages. The mechanism is also somewhat 
complicated and likely to get out of order. 

The hopper closet consists of a deep earthenware 
or enameled iron bowl, with a water-seal trap directly 



136 TEXT-BOOK OF HYGIENE. 

underneath. The excreta are received directly into 
the proximal end of the trap, and when the water is 
turned on, the sides of the bowl are washed clean and 
everything in the bowl and trap swept directly into the 
soil-pipe. There is no complicated mechanism to get 
out of order, the trap is always in sight and the entire 
apparatus can always be kept clean and inoffensive, as 
there are no hidden corners or angles for filth to lodge. 
This form of closet is, probably, all things considered, 
the best for general use. 

The 'wash-out' closets are of various shapes, some 
having the trap in the boAvl itself, others having a 
double water trap. They are generally simple in con- 
struction, and not likely to get out of order They do not 
present any decided advantages over the simple hopper. 

Water-closets should not be enclosed in wooden 
casings as is almost universally done. Everything 
connected with the closet, soil and drain-pipes and 
water supply, all joints and fixtures should be exposed 
to view so that defects can be immediately seen and 
easily corrected By laying the floor and back of the 
closet in tiles or cement, such an arrangement can even 
be made ornamental, as suggested by Waring,* who says 
that a closet 'made of white earthenware, and stand- 
ing as a white vase in a floor of white tiles, the back 
and side-walls being similarly tiled, there being no 
mechanism of any kind under the seat, is not only 
most cleanly and attractive in appearance, but entirely 
open to inspection and ventilation. The seat for this 
closet is simply a well-finished hard wood board, resting 
on cleats a little higher than the top of the vase, and 
hinged so that it may be conveniently turned up. ex- 
posing the closet for thorough cleansing, or for use as a 
urinal or slop-hopper.' 

* Sanitary Condition of New York City. Scribner's Monthly. Vol. SXU.. No. 2, 
June, 1881. 



CONSTRUCTION OF HABITATIONS. 137 

Where the arrangement here described is adopted, 
extra urinals are unnecessary, and undesirable. Where 
they are used they should be constantly and freely 
flushed with water, otherwise, they become very offen- 
sive. The floor of the urinal should be either of tiling 
or enameled iron. 

B. Water Supply for Closets. — The water supply 
for flushing water-closets should not be taken directly 
from the common house water supply, but each closet 
should have an independent cistern large enough to 
hold a sufficient quantity of water for a thorough 
'flushing (four to six gallons) every time the closet is 
used. The objections to connecting the water closet 
directly with the common house supply are, that there 
is often too little head of water to. properly flush the 
basin, and secondly, if the water be drawn from a fix- 
ture in the lower part of the house, while the valve of 
a water-closet in an upper floor is open at the same 
time, the water will not flow in the latter (unless the 
supply pipe is very large), but the foul air from the 
closet will enter the water pipe, and may thus produce 
dangerous fouling of the drinking water. Hence, sep- 
arate cisterns for each water-closet should always be 
insisted upon. 

C. Traps. — Every water-closet, urinal, wash-basin, 
bath tub and kitchen sink should have an appropriate 
trap between the fixture and the soil-pipe. The trap 
should be placed as near the fixture as practicable ; as 
pointed out above, in the best forms of water-closet the 
bottom of the closet itself forms part of the trap. 

Traps differ in shape and mechanism. The sim- 
plest and most efficient are the ordinary CO or half-CO 
traps. These traps are of uniform diameter throughout 
and have no angles for the lodgment of filth. A free 
flush of water cleanses them perfectly, and they rarely 
fail to furnish a sufficient obstruction to the passage of 



138 TEXT-BOOK OF HYGIEXE. 

sewer air through them from the soil-pipe, unless the 
water has evaporated, or been forced out under a back- 
pressure of air in the soil-pipe, or been siphoned out, 
and thus the seal broken. 

The D trap and bottle trap are objectionable on 
account of the great liability of becoming fouled, by- 
filth lodging in the corners, while in the mechanical 
traps, like Bowers' ball- valve trap, Cudell's trap and 
others of this class, there is always danger of insuffi- 
cient seal, by filth adhering to the valve, and thus pre- 
venting its exact closure. 

Most of the traps now furnished by the dealers in 
plumber's supplies, have an opening in the highest part 
for attaching a vent-pipe. It has been found that the 
seal in most traps can be broken by siphonage, if the 
pressure of air on the distal side ( the side toward the 
soil-pipe) of the trap is diminished, or, on the other 
hand, by increase of pressure in the soil-pipe the water 
in the trap may be forced back into the fixture and 
thus sewer air enter the room. By providing for a free 
entrance and exit of air to the trap this breaking of 
the seal can be prevented. The ventilation of traps can 
however, be dispensed with, if the soil-pipe is of a 
proper diameter and extended through the roof. The 
elaborate extra system of ventilation of traps, so gen- 
erally insisted upon by plumbers and sanitary engineers 
is unnecessary. If the soil-pipe is of the proper size 
and height, siphonage of traps will not be likely to 
occur. The waste pipe connecting the fixture and the 
soil pipe should be as short as possible : in other words 
all water-closets, urinals, baths and lavatories should 
be placed as near the soil pipe as practicable, in order 
to have no long reaches of foul waste pipe under floors 
or in rooms. 

D. The Soil-Pipe. — The vertical pipe connecting 
the water-closets and other fixtures with the house- 



CONSTRUCTION OF HABITATIONS. 139 

drains, is called the soil pipe. It should be of iron, 
securely jointed, of an equal diameter (usually four 
inches) throughout, and extend from the house-drain 
to several feet above the highest point of the house. 
The connexion of all the waste-pipes from water-closets, 
baths, etc., should be at an acute angle, in order that 
an inflow at or nearly at right angles may not pro- 
duce an obstruction in the free passage of air up and 
down the soil-pipe. The diameter of the soil-pipe at 
its free upper end should not be narrowed ; in fact, 
according to Col. G-eo. E. Waring, the up-draught is 
rendered more decided, if the upper extremity of the 
soil-pipe is widened.* The internal surface of the pipe 
should be smooth, and especial care should be taken to 
prevent projections inward at the joints ; otherwise 
paper and other matters will adhere to the projections 
and gradually obstruct the pipe. 

E. The House- Drain. — The horizontal, or slightly 
inclined pipe which connects the lower end of the soil- 
pipe with the sewer or cess-pool, the point of final dis- 
charge from the house, should be of the same diameter 
and material as the soil-pipe. The joints should be 
made with equal care, and the pipe should be exposed 
to view throughout while within the house-walls. If 
sunk below the floor of the cellar it should be laid in a 
covered trench, so that it may be readily inspected. 
The junction between the vertical and horizontal pipe 
should not be at a right angle, but the angle should be 
rounded. The drain-pipe should not be trapped. This 
is contrary to the advice of sanitary authorities gen- 
erally, but the author thinks it unadvisable to trap 
the drain-pipe. There should be no obstruction to the 
outflow of sewage from the house, and a trap in the 
drain-pipe is of no avail against the passage of sewer 
air from the sewer or cess-pool into the soil-pipe, if 

* Am. Architect, Sept. 15th, 1883. p. 124. 



140 TEXT-BOOK OF HYGIENE. 

the pressure of the air in the former is increased. Fur- 
thermore, if the passage of air backward and forward 
between the sewer and the external air at a sufficient 
height (above the roofs of houses, for example), is 
free and unobstructed, the sewers (or the cess-pool, as 
the case may be) will be better ventilated than if an 
obstruction to such free circulation, in the form of a 
trap, be placed in the drain-pipe. 

Nearly all sanitary authorities direct that an open- 
ing for the admission of fresh air, — 'fresh air inlet,' 
— should be made in the drain-pipe, before its connex- 
ion with the sewer or cess-pool. This is done with the 
view of having a constant current of fresh air entering 
near the base of the soil-pipe and passing upward 
through it. Theoretically the current ought always to 
pass in this direction. Practically, however, the cur- 
rent is found, at times, to pass the other way, and the 
foul air from the soil-pipe may be discharged into the 
air near the ground, where it would be much more like- 
ly to do harm than when discharged high up in the air 
beyond the possibility of being breathed. 

OFFICIAL SUPERVISION OF THE SANITARY ARRANGE- 
MENTS OF DWELLINGS. 

In most cities and towns, the municipal authorities 
have provided for an official inspection of buildings, to 
prevent neglect of precautions against fire and other 
manifest dangers to life. It is only very recently how- 
ever that the authorities of some of, the larger cities in 
this country have enacted laws to prevent improper 
construction of house drainage works. Although none 
of these laws or ordinances cover the subject, yet their 
proper enforcement must result in great advantage. 

Within the past few years, following the example 
of Edinburg, volunteer associations have been organ- 
ised in various cities of this country, with the object 



CONSTRUCTION OF HABITATIONS. 141 

of securing constant expert inspection and supervision 
of the drainage arrangements of dwellings, and other 
necessary sanitary improvements. 

The good results accomplished by the Newport 
Sanitary Protection Society, the New Orleans Auxil- 
iary Sanitary Association and other similar bodies 
attests the usefulness of such organisations. 

[The following works are recommended to the 
student who desires a fuller knowledge on the subjects 
treated in this chapter : 

W. H. Coreteld : Dwelling Houses, Tlieir Sanitary Construction and 
Arrangements. N. Y. 1S80. Wm. Paul Gerhard : House Drainage and 
Sanitary Plumbing; Fourth Report State Board of Health of R. L, 1881. 
Eliot C. Clarke: Common Defects in House-Drains. Tenth Annual 
Report Mass. State Board of Health, 1879.] 



CHAPTER VII. 

CONSTRUCTION OF HOSPITALS. 

SITE. 

If the choice of a site for the habitations of healthy 
persons is a matter of vital importance, as was pointed 
out in the last chapter, it needs no argument to impress 
upon the reader the actual necessity of choosing a site 
with wholesome surroundings for a habitation for the 
sick. In selecting a site for a hospital, therefore, it is 
of prime importance to avoid a location where unsan- 
itary influences prevail. 

While a hospital should always be easily accessi- 
ble, it is not desirable that it should be in a noisy or 
crowded part of a city. Where a hospital is primarily 
designed for the reception of accident, or 'emergency' 
cases, it is of course necessary to have it near to Avhere 
accidents are likely to occur. In a city, this will prob- 
ably be in the most crowded and noisy part. 

The direction of the prevailing winds from the city 
should be avoided, in selecting a site for a hospital. 

Free admission of sunlight and air must be secured 
to all parts of the hospital. An elevated location is 
therefore desirable, although exposure to violent winds 
must, if possible, be avoided. 

The soil upon which a hospital is built should be 
clean, easily drained, with a deep ground-water level. 
not liable to sudden oscillations. The neighborhood 
of a marshy, or known malarious region should be 
avoided. 

THE BITLDIXGS. 

The building area must be large enough to permit 
the construction of buildings in accordance with the 



CONSTRUCTION OF HOSPITALS. 143 

modern recognized principles of hospital construction. 
Overcrowding is not permissible; either of the grounds 
by buildings, or of the buildings by patients. 

Having determined upon the number of patients 
for whom provision is to be made, and the character of 
the diseases to be treated, an estimate must be made of 
the area necessary for a hospital. Taking into account 
all the buildings needed, the area required will be — for 
two or more storied buildings — not less than three 
hundred and twenty-five square feet per bed. If one 
story buildings are to be erected, more space will be 
required, and if infectious diseases are to be treated in 
the hospital, the above space allowance must be doubled 
or trebled. In the new Johns Hopkins Hospital in 
Baltimore, the area occupied by the buildings is four- 
teen acres, and provision is to be made for three hun- 
dred patients. This, covering, of course, the area oc- 
cupied by the administration buildings, nurses' home, 
kitchen, dispensary, operating and autopsy theatre, 
laundry, etc., gives an area of 2,020 square feet per 
bed. The actual allowance of floor space per bed is one 
hundred and twenty square feet; for patients with in- 
fectious diseases, the space allowance is nearly treble, 
being three hundred and ten square feet. 

Within recent years, the principles of hospital 
construction have undergone considerable modification. 
While formerly large hospitals consisted usually of one 
large, two or more storied buildings, in which all the 
various departments were comprised under one roof, the 
aim has recently been to scatter the wards as much as 
practicable consistent with reasonable ease of super- 
vision and administration. Under the former plan, 
with large wards connected by common corridors and 
stairways, ease of administration was primarily se- 
cured; in the latter the most important object of a hos- 
pital, 'a place for the sick to get well in,' is more 



144 TEXT-BOOK OF HYGIENE. 

nearly attained. While many hospitals are still being 
constructed on the old plan, of a single block of several 
stories in height, nearly all sanitary authorities are 
agreed that the plan of separate pavilions of one, or 
at most two stories, in which the buildings are entirely 
disconnected, or connected only by means of an open 
corridor for convenience of administration, is best for 
the patients, and leaving out of account the cost of the 
ground, are also the most economical. 

The recent development of the pavilion system of 
hospitals may be attributed largely to the success ob- 
tained in treating the sick and wounded in the simple 
barrack hospitals during the late war between the 
States. The army barrack hospital is the original type 
of the pavilion hospital of the present day. 

Each pavilion consists of one or two wards, con- 
taining from ten to thirty beds altogether. In each 
pavilion or ward is also a bath and wash room, water- 
closet, dining room, scullery, attendants' room, and 
sometimes a day-room for patients able to be out of 
bed. 

The two-story pavilion is built on the same plan 
and is generally adopted in cities, or where economy of 
space is desirable for financial reasons, and where no 
infectious diseases are treated. Where practicable, one 
story pavilions should always be adopted, as they are 
more easily heated, ventilated and served than two- 
storied buildings. 

When a number of pavilions or wards are con- 
nected by a corridor with each other and with a central 
or administration building, and other service buildings, 
the aggregation constitutes a modern pavilion block 
hospital. The Johns Hopkins Hospital, already re- 
ferred to, is a model hospital of this class, and its plans 
should be studied in detail by all who are more partic- 
ularly interested in hospital construction. The general 



CONSTRUCTION OF H08PITALS. 145 

wards are in one and two story buildings, connected 
by a corridor with each other, and the administration 
and service buildings. In addition to two buildings 
containing private rooms and small wards for patients 
able to pay for the extra accommodations, there are 
two lines of pavilions running from east to west. The 
corridor cuts all the pavilions near the north ends of 
the buildings, separating the ward almost entirely 
from the service part of the building. This arrange- 
ment leaves the south, east and west fronts of the 
wards entirely exposed to the sun's rays, a very 
important advantage. The kitchen and laundry are at 
opposite angles of the grounds, while the autopsy 
building is placed in the extreme northeast corner of 
the grounds, as far from all the wards as practicable. 
The free space between the separate pavilions 
should be at least twice the height of the building. In 
the Johns Hopkins Hospital, the space is fifty-nine 
feet and eight inches between the one-story common 
wards, which are thirty-seven feet in height from the 
surface of the ground to the ridge of the roof. 

VENTILATION AND HEATING. 

The cubic space (initial air space) per bed. in the 
wards should be not less than 1,500 to 2,000 cubic feet, 
and for surgical or lying-in cases, and contagious dis- 
eases, 2,500 cubic feet should be allowed. The ventila- 
ting arrangements should secure an entire change of 
the air two to three times in an hour. 

In most sections of the United States, natural ven- 
tilation can be relied on to keep the air in hospital 
wards pure (assuming, of course, the proper construc- 
tion of the buildings). The windows, doors, and walls 
are important factors in securing this ventilation. 
Hence, especial care is to be paid to their construction 
and arrangement. 



146 TEXT-BOOK OF HYGIENE. 

Many German, French and English authorities on 
hospital building, urge the importance of making the 
walls impervious by cement, glass, or paint. The pe- 
culiar odor known as 'hospital odor,' it is asserted, 
cannot be prevented in any hospital in which the floors, 
walls and ceilings are not absolutely impervious. The 
American practice is generally in favor of walls which 
permit transpiration of air. In the experience of the 
author the imperviousness of the walls is not neces- 
sary to secure freedom from hospital odor. It remains 
a question for serious consideration whether the diminu- 
tion of natural ventilation would not counterbalance 
any good resulting from non-absorptive walls. 

The interior of the walls should be perfectly 
smooth and plain; no projections, cornices or off-sets 
of any kind are permissible. The desirability of this 
restriction was clearly expressed nearly a hundred 
years ago by John Howard : ' From a regard to the 
health of the patients, I wish to see plain, white walls 
in hospitals, and no article of ornamental furniture 
introduced.'* 

Windows should run quite to the ceiling, and 
should not be arched, but finished square at the top. 
There should be one window for every two beds. The 
window sash should be double to retain heat, and the 
lights, heavy clear glass. Ventilation can be promoted 
by raising the outer sash from below, and lowering the 
inner one from above. The insertion of a Sherringham 
ventilator at the top of the inner sash will aid in giv- 
ing the incoming air- current an upward direction. 

Heating is best accomplished by introducing hot 
air from without, or by stoves or fire-places in the cen- 
tre of the wards. Where hot air is introduced from 
without, it should be heated by passing it over steam 

* An Account of the Principal Lazarettos of Europe, etc. London, 1791, p. 57. 



CONSTRUCTION OF HOSPITALS. 147 

or hot water coils, and not by passing it through a fur- 
nace, which may produce super-heating and excessive 
dryness of the air. 

In series of experiments by Dr. Edward Cowles at 
the Boston City Hospital,* the air was heated to 90° 
by passing it over steam coils. It was admitted to the 
wards by numerous inlets, one foot square. The best 
velocity for ventilating and warming purposes was 
found to be 180 feet per minute. Exit openings were 
in the ceiling, and it was found best to make them 
large, as by this means the rapidity of exit currents is 
reduced. 

Where the warming of the ward must be accom- 
plished by stoves or fire-places in the ward, the best 
plan, for square and octagon wards, is to have a large 
central chimney with arrangements on the four sides 
for fire-places or stoves. This chimney can also be 
used as a very efficient ventilating shaft throughout 
the year, by a device put in practice by Mr. John R. 
Neirnsee, architect of the Johns Hopkins Hospital, f 
In oblong wards, two or more large stoves placed at 
equal distances along the centre of the wards will heat 
the wards effectually. 

Floors should be made of tiles, slate, or oak or 
yellow pine lumber. If wood is used, it should be 
well seasoned, perfectly smooth, and all joints accu- 
rately made. The floor should be kept constantly 
waxed to render it impervious to fluids. 

The space between the floor and ceiling below 
should be filled with some fire-proof non-conducting 
material, such as cement, or hollow bricks, in order to 
isolate each floor or ward as much as possible from 
others, both to prevent transmission of noise and ex- 
tension of fire. 

* Report of the MassaohusettB State Board of Health for 1879, p, 231-248. 
+ Hospital Construction and Organisation. Plans for Johns Hopkins Hospital, 
N. Y., 1875. p. 335 ,et. seq. 



148 TKXT KOOK OF HYGIENE. 

All corners and angles on the inside of the build- 
ing should be rounded to facilitate the removal of 
dust. 

In cleaning up, care should be taken not to stir up 
the layers of dust too much, by active sweeping or 
dusting. The floors, furniture, door and window-cas- 
ings should be wiped off with damp cloths. Soiled 
bedding, clothing, dressings and bandages must be 
promptly removed from the ward. Mattresses and 
other bed-clothing should not be shaken in the 
ward. * 

Water-closets — or where the dry method of removal 
of excreta is in use — earth or pail-closets should be 
plri^fd where they can be easily reached by the patient?. 
buc the apartment in which they are placed must not 
open directly into the ward. The entrance to this 
apartment should be from the corridor, or better still, 
from the open air. The ventilation of water-closets 
should be independent of, and entirely distinct from 
that of the ward, or other part of the hospital building. 

It is, of course, unnecessary to more than call at- 
tention to the vital importance of the prompt removal 
of all excreta, both solid and liquid, from the ward or 
hospital building. To attempt disinfection of excreta 
and allow them to remain in the ward after being voided, 
is a pernicious practice, which should under no circum- 
stances be permitted. All utensils for the reception 
of excreta, bed pans, etc., should be immediately 
emptied and thoroughly cleansed. 

Urinals are not advisable; the simple hopper closet 
with hinged hard-wood seat, as described in chapter 
VI. is sufficient. 

A bath room and lavatory should be attached to 
every ward. It should be placed in the service build - 

* A Wernicii : leber Verderbene Luft in Krankenweumen. Youmakk'b Samml. 
Klin, Vortr., No. ITS), p. 34. 



CONSTRUCTION OF HOSPITALS. 149 

ing, and be easily accessible to the patients. There 
should also be portable bath tubs in order that baths 
may be given in the wards when necessary. 

Every large general hospital should also liave a 
special apartment or building where baths of various 
kinds, such as medicated, vapor, Turkish and Russian 
baths could be given. In lying-in hospitals, special 
arrangements for giving vaginal and uterine douches 
must also be furnished. 

A daily water supply of at least one hundred gal- 
lons per bed should be provided. The water should be 
easily accessible from the wards and various parts of 
the service building. 

All water-closets, soil and waste-pipes must be 
properly trapped; all joints must be properly made and 
all sewer connexions made on the most improved plans. 
All work of this sort should be properly tested before 
being accepted, and frequently inspected afterward. 

No sewer or house-drain should be laid under a 
ward. 

A disinfecting chest for disinfecting soiled cloth- 
ing, bedding, dressings, etc., should be placed in the 
basement of the ward, and connected with the latter 
by an iron chute, closing perfectly by an iron top. The 
best and most convenient disinfectant is steam. This 
is also the best means to destroy vermin in clothing 
and bedding. 

It is questionable whether a nurses' room should 
be attached to a hospital ward. The nurse's place, 
when on duty, is in the ward itself, not in a room sep- 
arate from it. Where there is a nurses' room, it should 
not be furnished with sleeping arrangements, for this 
is a strong temptation to neglect of duty on the part 
of the nurse. A nurse not on duty should not be per- 
mitted to remain about the ward. 



150 TEXT-BOOK OF HYGIENE. 

A ward-kitchen should be in the service building, 
where articles of food can be kept hot, or cold, when 
necessary, and where special dressings, cataplasms, 
hot water, etc., can be prepared. A small gas-stove 
only should be allowed in the ward-kitchen, as the reg- 
ular meals of the patients are prepared in the central 
kitchen, which should be totally detached from the 
hospital. The ward-kitchen can be easily utilised as a 
nurses' room, and in a small hospital can also be used 
as a store-room for the patients' body and bed linen, 
and clothing. 

The dining room for patients able to be out of bed 
should be in the service building. A room with good 
light, and well ventilated and heated should be selected 
for this purpose. In the intervals between meals this 
room could be used as a day room for such patients as 
should be out of bed, but who are not able to be in the 
open air. 

A dead-house, containing a dead room, autopsy 
room, and a room fitted up for rough microscopic, and 
possibly, photographic work, is a necessity to every 
well-appointed general hospital. The dead-house should 
be entirely separate from the ward buildings. 

The kitchen should be separate from the other 
buildings, and, in large hospitals should also be the 
central station for the heating arrangements, if hot 
water or steam heat are used. The laundry may be 
connected with it. The kitchen should be connected 
with the wards by means of a covered corridor to avoid 
exposure in carrying the food to the wards. 

The administration building should contain office 
rooms for the superintendent and resident physician. 
pharmacy, library, reception rooms for visitors, living 
rooms for one or more assistants, and dwellings for the 
superintendent and resident physician. 



CONSTRUCTION OF HOSPITALS. 151 

THE ADMINISTRATION AND MANAGEMENT OF A GENERAL 
HOSPITAL. 

The general management of a hospital should be 
under the direction of a superintendent, who besides 
being a medical man, should be especially qualified by 
study and experience for the work. The superintend- 
ent of a large hospital should not be expected to per- 
form any of the routine professional work in the wards, 
but he should be responsible for the service, both pro- 
fessional and lay, in the hospital. He should be the 
financial officer, and in all things concerning the hos- 
pital his judgment should decide. He should have 
sufficient assistance to permit all necessary duties to 
be promptly performed. For this purpose, he should 
have a secretary, or clerk, who should not be a medical 
man; otherwise the attention of the latter might be 
withdrawn from his clerical duties to the more inter- 
esting professional work in the hospital. The plan 
advocated by some authorities, to have two superin- 
tendents for large hospitals, one of whom shall be a 
medical man and direct only the professional work of 
the hospital, while the other shall have charge of the 
administrative functions, does not commend itself to 
the author. It involves a division of responsibility 
which will in nearly all cases, eventually lead to differ- 
ences of opinion likely to prove unfavorable to the best 
interests of the hospital. 

It is customary in this country to appoint as resi- 
dent physicians and surgeons in hospitals, recent grad- 
uates, whose functions are usually limited to carrying 
out the directions of the visiting physicians and sur- 
geons, and sometimes to act on their own responsibility 
in emergencies. This system has some advantages for 
the physicians, but is usually detrimental to the best 
interests of the patients. The resident medical officer 
in a large hospital should always be a thoroughly qual- 



152 TEXT-HOOK OF HYGIENE. 

ified, experienced physician, capable of deciding 
promptly when the occasion arises, and he should be 
responsible to the superintendent for the proper perfor- 
mance of his professional duties. Necessarily, a phy- 
sician with the qualifications indicated, would demand 
a very much larger salary than is usually paid resident 
physicians, but it should be understood, that no hos- 
pital, in which the good of the patient is the first con- 
sideration can be conducted on a cheap basis. 

Visiting physicians and surgeons, and all resident 
medical officers should be chosen with reference to their 
general and special qualifications for the duties expected 
of them. It would seem to be a good plan to make the 
selections for subordinate positions at least, by compet- 
itive examination. 

The sick in a hospital should be properly classified. 
Male and female patients, should of course be treated 
in separate wards. A primary classification into med- 
ical, surgical and obstetrical cases or wards, is also 
indicated. Infectious diseases, such as typhoid fever, 
erysipelas, cholera, yellow fever, croupous pneumonia, 
etc.. should not be treated in the same wards with rheu- 
matism. Bright's disease, cardiac and nervous disorders. 
or simple digestive derangements. It is questionable. 
however, whether it is advisable to make a very elab- 
orate classification of the various diseases, except in 
very large hospitals. 

An accurate record, made at the time of observa- 
tion, and not written from memory afterward, should 
be kept, of the history and progress of every case- 
The record should show, not merely the symptoms and 
diagnosis, but the medical and hygienic treatment. In 
most hospitals where such records are kept, the entries 
are made either in a simple memorandum book, or in a 
more or less complicated case record. A simple form 
of case record has been devised bv Surgeon Walter 



CONSTRUCTION OF BOSP1TAL8. 158 

Wymau. V. S. Marine Hospital Service, which seems 
to possess advantages thai render its general adoption 
desirable. 

In hospitals where cases of surgical diseases and 
injuries are received, a special apartment should be 
fitted up as an operating room. Operations should not 
be performed in a ward in the presence of other patients. 

| The following works are recommended for addi- 
tional study upon this subject: 

Hospital Construction and Organisation; N. Y. 18 7 5. (especially the 
essays .>f Drs. Billings, Folspm and Stephen Smith-.) Krankenanstalten. 
by L. Deokn, in V. Pettenkofer unt> ZrKMssKN'sIIandbuchder Hygiene. 
Spital, by C. BiiiiM. in Realencyclopadie d. ges. Hedkunde. Bd. XII. Gen- 
eral Principles of Hospital Construction, by F. II. BhownJii Buck's Hygiene 
and Public Healt!,. Vol. \ \ 



CHAPTER VIII. 

SCHOOLS. 

The hygiene of schools comprises the consideration 
of the sanitary principles underlying the construction of 
school-houses and school furniture, the proper amount 
of time to be devoted to study at different ages, the spe- 
cial diseases of school-children, their causes, and means 
for their prevention. 

CONSTRUCTION OF SCHOOL HOUSES. 

In the construction of school-houses, the same hy- 
gienic principles are applicable as in dwelling-house 
construction. The selection of a site for the school- 
building should command the same careful considera- 
tion that is necessary in determining upon a site for a 
dwelling. Proximity to marshes and other unsanitary 
surroundings should be avoided. If the soil is damp, 
it should be properly drained, and all sources of insa- 
lubrity in the neighborhood avoided, or, if possible, 
removed. 

School houses should not be over three stories high; 
corridors and stairways should be wide, straight, and 
well lighted. All stairs should be securely built, and 
be guarded with ample, strong railing. All doors 
should open outward to permit ready egress, and re- 
duce the danger of accident in panics from any cause. 

In addition to the study, or recitation rooms, pro- 
vision should be made for play and calisthenic exercise 
rooms. Well-lighted and ventilated side-rooms should 
be provided for the reception of outside clothing, um- 
brellas, overshoes, etc. These articles should not be 
kept in the recitation or study rooms. 



SCHOOLS. 155 

Floors should be made of accurately jointed floor- 
ing, rendered impervious by oil or paraffin coating. 

Appropriate measures must be employed to prevent 
the permeation of the building by ground-air. 

The inside walls of school-rooms may be tinted a 
neutral gray, or light blue or green. Ceilings should 
be white. Walls and ceilings should not be painted, 
but lime-coated to permit free transpiration of air. 

Schools should be so constructed as to permit of 
ready heating, and ventilation, cleaning and keeping 
clean. In large schools, the method of heating will 
usually be by furnace-heated air, although a better 
method would probably be by steam or hot-water pipes. 

The ventilation of school-rooms must be carried 
out on the principles indicated in chapter I. With 
careful and intelligent teachers, natural ventilation 
will give better satisfaction than a complicated arti- 
ficial system. 

A model study room, according to modern views, 
should be about thirty feet long, not over twenty-two 
feet wide and fourteen feet high. Such a room could 
be easily lighted by windows on one side only, and 
readily heated and ventilated. It would also enable 
the teacher to exercise a close supervision over his pu- 
pils. In a room of this size forty pupils would be a 
proper number, although fifty could be accommodated. 
The initial air-space for each pupil would be 135 cubic 
feet if there were fifty pupils in the room, and 231 
cubic feet if there were only forty. This would be 
slightly reduced by the allowance for the teacher. 

It is believed that study rooms should face toward 
the north. The light entering from the north side of 
a building would be equable during the whole day. 
While a larger window surface would be necessary 
than with an easterly or southerly exposure, it is held 
that the light being devoid of all glare, would be more 



156 TEXT-BOOK OF HYGIENE. 

effective. Where the light is admitted on the east. 
south, or west sides of the building, the direct entrance 
of the sun's rays must be prevented by curtains, by 
means of which the amount and proper distribution of 
the light is regulated with difficulty. 

The windows of the school-room should reach from 
about the height of the pupils' shoulders (when seated i 
to nearly, or quite to the ceiling. Arches or overhang 
ing cornices over the windows should be avoided, as 
they cut off much light. For the same 7-eason the near 
proximity of other high buildings, and of trees should 
be avoided in selecting a site for a school-house. The 
window area should be not less than one-fifth of tin- 
floor area, otherwise the light will be deficient. 

The light should be admitted only from the left 
side of the pupil. When admitted from the right side 
the shadow cast by the pen in writing interferes with 
good vision; if admitted directly in front of the pupil the 
glare of the light will injuriously affect the eyes, while 
if it enters from behind, the book or paper of the pu- 
pil will be so much in shadow as to compel him to lean 
so far to the front in bringing his eyes nearer to book 
or paper, that nearsightedness is very likely to be de- 
veloped. Furthermore, if the light is admitted into 
the room at the backs of the pupils, the eyes of the 
teacher are liable to suffer from the constant glace. 

In a school-room of the dimensions above stated. 
a row of windows on one side, forming an area of glass 
one-fifth of the floor-space, will thoroughly and satis- 
factorily illuminate the room, with the least unfavor- 
able influence upon the organs of vision. It is advisa- 
ble, therefore, to always insist on this arrangement of 
lighting of school rooms. Where artificial light is 
used in a school-room, it should be in the proportion 
of one burner to every four pupils. All burners should 
be provided with chimneys and vertical reflectors, 



schools. 157 

Water-closets and privies should not be placed in 
<Hlla.is or basements. This would seem to be self-evi- 
dent, and yet, in many city school-houses these places 
of retirement are in this unsuitable location. When it 
is considered that large schools are frequently warmed 
by hot air taken from the cellar, it furnishes an addi- 
tional reason to avoid this location for water-closets. 
On the contrary, the custom, in some country schools, 
of placing the privy at a considerable distance from the 
school-room and in an exposed situation, is almost 
equally reprehensible, as the pupils, especially girls, 
are prone to neglect obeying the calls of nature, from 
which neglect many disorders arise. 

SCHOOL 11 UMTIKK. 

Desks should be slightly sloping, the edge nearest 
the pupil being about one inch higher than his elbows. 
The front edge of the seat should project a little beyond 
the near edge of the desk, so that a plumb-line dropped 
from the latter should strike the seat near its front 
edge. If the seat is not thus brought slightly under 
the desk, the pupil is compelled to lean forward in 
writing, which position prevents proper expansion of 
the chest and increases the blood-pressure in the eyes, 
a condition promotive of nearsightedness. 

Seats should be only high enough so that the feet 
rest hat upon the floor. If they are higher, a foot- 
board must be provided. Children should not be con- 
demned to the cruelty of having their feet dangling 
•between heaven and earth' while they keep their seats. 
Seats and desks should be graded according to the sizes 
of the pupils — not their ages or standing in the class. 

Ah ideal seat and desk would be one made to mea- 
sure for each pupil, but this is manifestly impractica- 
ble, inasmuch as with the constant growth of the child 
the seats would be rapidly outgrown. 



158 TEXT-BOOK OF HYGIENE. 

Blackboards should not be placed at a greater dis- 
tance than thirty feet from the farthest pnpil. The 
ground of the board should be a dead black, without 
lustre. In writing exercises upon the board, care should 
be taken that the letters and figures are made sufficiently 
large, and with rather heavy strokes of the crayon y in 
order that they may be easily seen from the most dis- 
tant part of the room. It has recently been demonstra- 
ted that a black letter on a white ground can be seen 
at a greater distance than a Avhite letter on a black 
ground. Hence, it might prove advantageous to the 
eye-sight of school-children, to substitute for the pres- 
ent blackboard and chalk, a white board and black 
crayon. In some European lecture rooms, this plan 
has been adopted with satisfaction. 

AMOUNT OF TIME TO BE DEVOTED TO STUDY. 

Young children should not be kept at the same 
study, or in the same position for long at a time. The 
exercises should be frequently varied. It is especially 
with children in the primary grades that care should 
be taken not to overburden their minds with too many 
hours of study, or too long continuance at the same 
exercise. 

Children should not be placed in school much, if 
at all, before the completion of their seventh year. 
From seven to nine years, they should be kept at their 
studies not longer than three hours daily; from nine to 
twelve years, four hours may be allotted them, and from 
twelve to sixteen years, they may be kept at mental 
work five to six hours daily. This does not mean that 
pupils are to be kept continuously at their studies during 
these hours, but that they should be neither compelled, 
nor permitted to study longer than these periods each 
day. It is believed that these figures represent the 
capacity for endurance in the majority of children, and 



SCHOOLS. 159 

they should be adopted in all schools where the largest 
return in mental acquirements is desired at the least 
expenditure of health. Excess of time expended in 
study is almost certainly followed by physical deteri- 
oration. 

Gymnastic exercises should form part of the daily 
routine in all schools. These exercises should take 
place, when practicable, in the open air. Playing, 
romping, laughing and singing should be encouraged, 
rather than the natural tendency to boisterous play 
restrained. It is especially desirable that the female 
children should be encouraged to take part in these 
diversions. The desire, on the part of many parents, 
to see little girls deport themselves as young ladies, 
before the time even when they write their age in two 
figures, is very reprehensible, and deserves the most 
unqualified condemnation. 

DISEASES OF SCHOOL CHILDREN. 

The principal diseases incident to school life are, 
myopia, spinal deformities, nervous and digestive dis- 
orders, pulmonary phthisis, and contagious diseases. 
It is believed that by judicious sanitary measures these 
can all be very much diminished and some entirely 
prevented. 

It has been shown by the examination of the eyes 
of school-children, that nearsightedness increases pro- 
gressively from the lowest to the highest classes. Chil- 
dren who enter school with an hereditary tendency to 
myopia or who are perhaps already nearsighted to a 
slight degree, soon become more intensely myopic, while 
others who may be even hypermetropic on entering 
school will be found to have become nearsighted during 
school life. In examinations of over 30,000 pupils of 
grammar and high schools, in Germany, Austria, Rus- 
sia, and Switzerland, it has been found that the aver- 



160 TEXT-BOOK OF HYGIENE. 

age proportion of nearsightedness is a fraction over 
40 per cent., varying in the different classes from 22 
per cent, for the lowest, to 58 per cent, for the highest 
classes. These figures represent the averages of all the 
examinations made. In some particular schools, for 
example, in the gymnasium (high school) of Erlangen. 
the percentage in the higher classes was 88 percent., 
in the gymnasium of Coburg, 86 per cent., and in the 
gymnasium of Heidelberg the proportion of myopic 
students in the highest class is said to have reached 100 
per cent, in 1877. In the primary schools the percent- 
age was found to be much lower. These observations 
show that the number of myopic individuals bears a 
constant relation to the intensity of use of the visual 
organs. The results of the observations of different 
observers in different countries also uniformly point 
to the conclusion that not only does the number of 
nearsighted pupils increase as the higher classes are 
reached, but the degree of myopia increases likewise. 
Thus a pupil who may have only a moderate degree of 
myopia on entering the school will have myopia in a 
higher degree as he advances in his classes. Erismann 
found, on re-examining the same pupils annually, that 
in six years, 13.14 per cent, of those examined had 
developed myopia from emmetropia. while in 24.57 per 
cent, of nearsighted pupils, the degree of myopia had 
increased.* 

The principal causes of the prevalence of near- 
sightedness in schools are badly arranged, or insuffi- 
cient light, bad air, overheating of the school-rooms, 
improper construction of desks, compelling children to 
lean forward while reading or writing, and badly printed 
text-books. The use of small type, poor paper, and 
bad press-work in text-books is very reprehensible. 



* Erismann: Die Hygiene derSehule. in von PfetTKftKOMtK urn! lifUSSEK's Band 
der Hygiene. It Tta., SAbth., p. SO. 



SCHOOLS. 161 

The type technically known as long primer, one size 
smaller than that used in this book, is the smallest 
that should be used in text-books. That badly ar- 
ranged light and improper seats are causes of myopia, 
has been shown by Florschutz in his examinations of 
the pupils in the public schools of Cobnrg. He found 
that in the newer schools in which the light and seats 
are better arranged, the percentage of nearsight de- 
creased. The average percentage of those examined 
in 1874 was twenty-one, while in 1877 it had been re- 
duced to fifteen,* showing the great improvement due 
to the application of correct sanitary principles in con- 
struction of school-houses. 

Defective hearing has recently been shown to be 
especially frequent among school children. A Berlin 
aurist found 1,392 children out of 5,902 (23.6 per cent.) 
suffering from ear disease of some kind. Dr. Samuel 
Sexton, of New York, and Dr. Chas. F. Percivall, di- 
rector of music in the public schools of Baltimore, 
have arrived at similar results after examination of a 
large number of school children. 

Spinal curvature is present in a large proportion 
of the children attending schools. Statistics are not 
very full upon this subject, but one author, Gruillaume, 
states that he found lateral curvature of the spine in 
218 out of 731 school children, a proportion of 29.5 
per cent. This, of course, includes the slighter degrees 
of curvature, which cannot properly be termed a dis- 
ease. M. Eulenburgf found that among 1,000 persons 
with lateral curvature of the spine, the disease began 
in 887 between the ages of six and fourteen, that is to 
say, during the years of school life. Girls are affected 
ten times as often as boys. 

The especial causes of spinal curva&ire occurring 
during school life, are improperly constructed seats 

* Quoted by Cohn in Realencyclopsedie d, ges. Heilk. Bd. 12, p. 2fSJ. 
t Realencyclop.-edie d. ges. Heilk. Bd. XI. p, 564. 



162 TEXT-BOOK OF HYGIENE. 

and desks, and an improper position of the body. 
Many pupils habitually assume a 'twisted' position, 
which is very liable to produce spinal distortion in 
children of weak muscular development. An improper 
position is more likely to be unconsciously assumed by 
girls than by boys. The clothing is responsible for 
this, for when the girl files into her place behind the 
desk, her clothing, hanging loosely about her, is swept 
back, and forms a pad, upon which she sits with one 
buttock. The greater elevation of her seat on that 
side throws the spinal column out of the vertical line, 
which is compensated by a partial twisting of the 
trunk. The attention of teachers should be directed 
to this faulty habit, which can be easily corrected, and 
its consequences averted by timely interference. 

Nervous disorders are comparatively frequent 
among school-children. Headaches are often due to 
insufficient ventilation, improper food, bad digestion, 
and excessive mental strain. Defective light may also 
be the cause of headaches, by causing ocular fatigue. 
Hysterical and imitative affections are not infrequent, 
and sometimes pass through entire schools, including 
even the teachers. Girls are of course more subject to 
this class of disorders than boys, but the latter are not 
entirely exempt. 

Derangements of the digestive organs are exceed- 
ingly frequent among school-children. They can gen- 
erally be traced to the use of improper food. The eat- 
ing of cold lunches should be discouraged as much 
as possible. 

Nuts, candies, pies, fruit-cakes, and above all 
pickles, are most fruitful sources of digestive derange- 
ments of children. The absence of proper accommo- 
dations to enable children — especially girls — to answer 
the demands of nature, are frequent sources of diges- 
tive and nervous disorders. 



SCHOOLS. 163 

The seeds of pulmonary consumption are frequently 
implanted during school-life. A neglected cough, bad 
ventilation, under which term may be comprised over- 
heating and cold draughts, as well as polluted air, 
improper position of the body, excessive mental work, 
or underfeeding, may, any of them be the starting 
point of this fatal disease. 

Especial care should be taken to prevent the in- 
troduction or dissemination of contagious diseases 
through schools. The importance of this duty should 
be at all times impressed upon school boards and 
teachers. In the first place, no child should be admit- 
ted within the door of the school-room, unless it first 
presents undoubted evidence of protection againt small- 
pox, either by having passed through a previous attack, 
or by a proper vaccination. In case of an actual or 
threatened epidemic of small-pox, the entire school, 
including teachers, should be vaccinated. 

Diphtheria has been shown to be frequently spread 
through the agency of schools.* This fatal disease 
demands especial precautions on the part of teachers, 
and others involved in the management of schools, to 
prevent its introduction to these institutions. 

Children should not be admitted to school, coming 
from a house where there is at the time, or has recently 
been, a case of contagious disease, such as small-pox, 
diphtheria, scarlet fever, or measles. At least four weeks 
should be allowed to elapse after the termination of 
such disease before a child from the infected house is 
re- admitted to the school. It goes without saying that 
no cnild having itself been sick with a contagious dis- 
ease should be admitted to school until entirely restored 
to health. The above-mentioned limit of four weeks 

* H. B. Baker. The Relations of Schools to Diphtheria and to Similar Diseases. 
Public Health. Vol. VI, p. 107. 



164 TEXT-BOOK OF HYGIENE. 

is the briefest period allowable before the quarantine 
of the infected house (so far as the schools are con- 
cerned ) can be relaxed. 

When a case of contagious disease has accidentally 
obtained entrance to the school, the pupils should be 
dismissed for the day, and the room thoroughly dis- 
infected by means of sulphur or chlorine. 

Teachers are not infrequently guilty of the grave 
imprudence of sending pupils from the school to the 
house of an absent child to inquire the reason of the 
latter' s non-appearance at school . It frequently happens 
that the absent child is sick, and the messenger is invi- 
ted to the sick-room to see his'or her class-mate. There 
can be no room for doubt that scarlet fever, diphtheria 
and measles have often been introduced into schools in 
consequence of such thoughtlessness on the part of 
teachers. 

In order to promote the proper hygienic manage- 
ment of schools, all teachers should be required to sub- 
mit to an examination in the principles and practice 
of hygiene, at least so far as school hygiene especially 
is concerned. This is a demand that school-boards 
could reasonably insist upon, and there can be no 
question that the improvement in the health of the 
pupils would amply justify the innovation. 

[Students may consult with advantage the follow- 
ing special articles : 

D. F. Lincoln : School Hygiene, in Buck's Hygiene and Public 
Health, Vol. II. F. Ekismann : Die Hygiene der Schule, in Von Petten- 
kofeb und Ziemssen's Handb. d. Hygiene, II. Th. 2 Abth. Recss : Schul- 
bankfrage, in Realencyclopadie d. ges. Heilk., Bd. XII. H. Cohn : Schul- 
kinderaugen, ibid. C. J. Lundy : School Hygiene. Public Health, Vol. IX. 



CHAPTER IX. 

INDUSTRIAL HYGIENE. 

One of the most interesting chapters in the study 
of hygiene is that which treats of the relations of oc- 
cupations to health and life. While it is unquestion- 
able that certain occupations are intrinsically danger- 
ous to health, there can be no doubt that in many in- 
stances incidental conditions not necessarily connected 
with the occupation are factors in the production of dis- 
eases. Such factors are bad ventilation and other in- 
sanitary surroundings, as well as in many cases, want 
of sufficient or proper food. 

Occupations induce disease by compelling the work- 
men to inhale irritating, poisonous, or offensive gases, 
vapors, or dust; or by causing the absorption through 
the skin or mucous membranes, of irritating or poison- 
ous substances. Changes of temperature, as exposure 
to great heat or cold, produce diseases which are, in 
some instances, characteristic. In another class of 
cases the excessive use of certain organs, as the ner- 
vous system, the eyes, the vocal organs, or various 
groups of muscles produce characteristic morbid effects. 
Again, a constrained attitude while at work, a seden- ' 
tary life, or occupations involving exposure to mechan- 
ical violence are recognised sources of disease and 
death. 

The following table gives the mortality and aver- 
age age at death of all decedents over twenty years of 
age, whose occupation was specified, in the State of 
Massachusetts, for thirty-one years and eight months. 
The -total number of decedents was 144,954; the aver- 
age age at death, 50.90 years. Subdivided into classes, 
and individual occupations, the results are as follows : 



166 



TEXT-BOOK OF HYGIENE. 



TABLE I. 

Occupations of Persons whose Occupations were specified, and whose Deaths were 
registered in Massachusetts during a period of thirty-one yean and eight 
months, ending with December 31, 1874.* 



OCCUPATIONS. 



c L ass I . (Jul tivators of 
the Earth : Farmers, 
Gardeners, etc 

class ii. Active Me- 
chanics abroad: 

Brickmakers 

Carpenters and Join- 
ers 

Caulkers and Gravers. 

Masons 

Millwrights 

Riggers 

Ship-Carpenters 

Platers 

Stone-cutters 

Tanners 

class in. Active Me- 
chanics in sho^s 

Bakers 

Blacksmiths 

Brewers 

Cabinet-Makers 

Calico-printers 

Card-makers 

Carriage-makers and 
Trimmers 

Chair-makers 

Clothiers 

Confectioners 

Cooks 

Coopers 

Coppersmiths 

Curriers 

Cutlers 

Distillers 

Dyers 

Founders 

Furnace-men 

Glass-blowers. . 

Gun-smiihs 

Hatters 

Leather-dressers 

Machi aists 

Millers 

Musical Instrument- 
makers 

Nail-makers 

Pail and Tub-makers . 

Painters. 



NUMBER AVERAGE 

AGE AT 
PERSONS. DEATH. 



31,832 

10,893 
106 

6,150 
180 

1,662 
118 
161 
873 
81 

1,025 
537 

16,576 

471 

2,402 



174 

5 

1,850 



OCCUPATIONS. 



Paper-makers 

Piano-forte-makers. . 
65.29 Plumbers 

Potters. 

56.19 Pump and Block-ma 
46.85 kers 

Reed-makers 

53.33 Rope-makers 

58.59 j Tallow-chandlers.. 

50.33 Tin-smiths 

59.14 Trunk-makers 

52.25 j Upholsterers 

58.53 | Weavers 

40.99 IWheelrights 

40 90 j Wood-turners 

50.36 Mechanics (not speci 

| ified). . . . '. , 

47 57 class iv. Inactive 
47.04 ! Mechanics in shops . 

53 26 Barbers 

47.11 M Basket-makers 

48.841 1 Hook-binders 

52.11 Brush-makers 

48.23 (Carvers 

Cigar-makers 

48 21 1 i Clock and watch-ma 

41.77 j kers 

56.50 Comb-makers 

44.11 Engravers 

40.82; I Glass-cutters 



NUMBER AVERAGE 

AGE AT 
PERSONS. DEATH. 



59.22 
45.89 
41.50 
3921 
56 85 
45.17 
42.51 
43.42 
37 88 
48.86 
54.67 
47.23 
4167 
57.14 

46.73 
41.49 



i Harness-makers 

Jewellers 

Operatives 

Printers 

Sail-mnkers 

Shoe-cutters 

Shoe-maker? 

Silversmiths or Gold- 
smiths 

Tailors 

Tobacconists 

Whip-makers 

j Wool -sorters 

class v. Laborers 
(no special trades). 

Laborers 

Servants 

Stevedores 

Watchmen 



2,015 

17,233 
403 
70 
150 
53 
90 
154 

100 
134 
124 
76 
423 
468 
2,138 
717 
217 



92 
1,393 
43 
99 
155 

28,058 



Thirty-third Registration Report of Massachusetts, p. CVII., et. seq. 



INDUSTRIAL HYGIENE. 



167 



TABLE I. Continued. 



OCCUPATIONS. 



"Workmen iu Powder- 
mills 

class vi. Factors la- 
boring abroad, etc. : . 

Baggage-masters 

Brakesmen 

Butchers 

Chimney-sweeps ... 

Drivers 

Drovers 

Engineers and Fire- 
men 

Expressmen 

Ferrymen. 

Lighthouse-keepers. . 

Peddlers 

Sextons 

Soldiers 

Stablers 

Teamsters 

Weighers and Gaug'rs 

Wharfingers 

CLASS VII. El 

on the Ocean 

Fishermen 

Marines 

Naval Officers 

Pilots 

Seamen 

class vni. Merchants, 
Financ'rs,AgHs,etc: 

Agents 

Bankers 

Bank Officers 

Boarding House k'prs. 

Booksellers 

Brokers 

Clerks and Bookkeep- 
ers 

Druggists and Apoth- 
ecaries 

Gentlemen 

Grocers 

Innkeepers 



JMBEh AVEBAcK 
OF I AGE AT 

RSflVS.I TIKiTH. 



18 

7,035 

87 

24(5 

537 

4 

327 

17 

567 
216 

9 

10 
417 
M 
2.885 
354 
1,282 
24 
22 

8,844 

433 

4 

58 

82 

8,267 

15,977 
376 
49 
151 
75 
73 
198 

3,435 

255 

1,512 

517 

467 



39.67 

36.29 
34.08 
26.54 
50.19 
34.50 
38.88 
49.29 

38.77 
41.3d 
53 78 
60 40 
45.18 
59.94 
28.37 
42.54 
40 35 
60.67 
50.00 

46.44 
42.82 
41.25 
50 00 
60 38 
46.45 

48 95 

46 76 
57.61 
55.14 

47 96 
53 05 
49.58 

35.93 

4237 
68.42 
47.59 
50.04 



OCCUPATIONS. 



Manufacturers 

Merchants 

Newsdealers and Car 

riers 

R. R. Agents or Con 

ductors 

Saloon and Restau 

rant keepers 

Stove Dealers 

Telegraphers 

Traders 

class IK. Professional 



Architects 

Artists 

Civil Engineers 

Clergymen 

Comedians 

Dentists. 

Editors and Rep'trs.. 

Judges and Justices. . 

Lawyers 

Musicians 

! Photographers 

Physicians 

Professors 

Public Officers 

Sheriffs, Constables & 

I Policemen 

[Students 

I Surveyors 

(Teachers 

(class x. Females:.. 

Domestics 

S I >ressmakers 

i Milliners 

Nurses 

i )peratives 

j Seamstresses 

I ^hoe-binders 

Straw -workers 

Tailoresses 

Teachers 

(Telegraphers . 



UMBEK AYbltAOE 



1,37b 

3,927 



12 

5 
2,908 

5.175 



117 
965 
32 

114 
87 
18 

676 

266 

10 

1,166 

45 

437 

158 



495 
3,343 
1.037 
259 
136 
116 
703 



51.53 
54.17 



39.85 
40.90 

45.25 

*8.80 
48.08 

50 81 
47.07 
44.18 
42.32 
58.57 
37 31 
41.61 
46.68 
64.11 
56.45 
41.59 
36.80 
54.99 
55.93 
55.37 

53.76 
23.23 
51.44 
41.79 
39.13 
46.64 
43.36 
39.42 
61.06 
27 82 
46.50 
43.12 
34.83 
47.49 
31.27 
24 43 



The above table cannot be absolutely relied upon 
for several reasons, the principal of which is that the 
table is incomplete. It shows, however, very clearly 
the relations of certain occupations to longevity. It 
is seen, for example, that agriculturists have the great- 
est expectation of life. Next to these come mechanics 



168 TEXT-BOOK OF HYGIENE. 

engaged out of doors. Professional men come next, 
and of these, clergymen and members of the bar have 
the first and second places, respectively. The expec- 
tation of life of physicians is above the average, being 
nearly fifty-five years. Mechanics engaged in active 
work indoors, may expect to live 3.70 years longer than 
those whose occupation requires them to retain a more 
or less constant position. 

Occupations which are accompanied by the forma- 
tion of much dust, either inorganic or organic, are es- 
pecially unfavorable. They usually produce diseases of 
the respiratory organs, which may eventuate in phthisis. 
In the table it is seen that the average age at death of 
stone-cutters was 40.90; of cotton factory operatives 
(male), 39.16; (female;, 27.82;* of cigar makers, 38.36, 
and of cutlers, 39.21 years. These figures more or less 
closely approximate the conditions which have been 
shown to exist in England and on the continent of Eu- 
rope. In Sheffield, the workmen who grind and polish 
the cutlery, called 'dry grinders,' are said to suffer 
from a characteristic pulmonary affection termed 4 grind- 
er's asthma,' (emphysema) in the proportion of 69 per 
cent, of the whole number employed. The average 
duration of life of the needle grinders of Derbyshire is 
30.66 years. Among the cutlery grinders of Solingen 
in Rhenish Prussia, OldendorfF found 29 per cent, suf- 
fering from pulmonary affections, while the average 
age at death of the 'dry grinders' was 40.7 years. 

OCCUPATIONS PREJUDICIAL TO HEALTH. 

The diseases of occupations may conveniently be 
divided into the following classes : 

* These figures must be accepted with much reserve. While it is probable that 
the average age at death among women engaged in different occupations is less than 
that, of men engaged in the same occupations, the figures in table I., class X. cannot 
be used as a basis of comparison. So many women are annually withdrawn from the 
various occupations, by marriage, which places them under different conditions that 
the statistics of the occupations of women in the table are untrustworthy. 



INDUSTRIAL HYGIENE. 160 

1. Diseases due to the inhalation of irritating or 
poisonous gases and vapors. 

2. Diseases due to the inhalation of irritating or 
poisonous dust. 

3. Diseases due to the absorption or' local action 
of irritating or poisonous substances. 

4. Diseases due to exposure to elevated or variable 
temperature or atmospheric pressure. 

5. Diseases due to excessive use of certain organs. 

6. Diseases due to a constrained attitude and 
sedentary life. 

7. Diseases from exposure to mechanical violence. 

I. — DISEASES DUE TO THE INHALATION OF IRRITATING 
OR POISONOUS GASES OR VAPORS. 

Sulphuric acid gas is used in various trades as a 
bleaching agent. In the manufacture of straw hats, 
and in the drying or 'processing' of hops this agent is 
extensively employed, and the people engaged in these 
industries frequently suffer from respiratory and diges- 
tive disorders. These are, however, rarely serious. If 
free access of air is allowed, the dangers to health in 
the above employments are very slight. 

Nitric acid fumes may be dangerous to health 
when inhaled in a concentrated form, but very few cases 
are on record where any positively deleterious influence 
can be traced to this agent. 

Hydrochloric acid fumes may prove deleterious 
to the workmen in soda manufactories, where the fumes 
are disengaged during the so-called 'sulphate process.' 
But the danger is probably slight. On the other hand, 
attention has recently been called to a peculiar effect 
of hydrochloric acid fumes upon the workmen in 
fruit-canning establishments. The men who seal or 
'cap' the cans after being filled, are the ones affected. 
The lesion has been described by Dr. W. Stump For- 



170 TEXT-BOOK OF HYGIENE. 

wood, who says concerning it. ' The constant inhalation 
of the fumes of muriatic acid, associated as they are 
with the lead solder, which the busy "capper" neglects 
to protect himself against, soon produces inflammation 
of the mucous membrane of the nose, which finally 
results in ulceration. AVith some patients, after the 
removal of the cause, and the application of proper 
treatment, recovery takes place after two or three 
months ; but with those who have a scrofulous taint 
in their constitutions, this ulceration is exceedingly 
intractable, and in spite of all treatment proceeds for 
months and even years, until the septum is finally per- 
forated. And strange to say, it is the common expe- 
rience of those who have suffered, that as soon as per- 
foration takes place, all the soreness and consequent 
annoyance disappears and the patient recovers, with. 
of course, a permanent opening in the nasal septum.' * 
Dr. Forwood adds that anointing the nose both within 
and without several times a day, and avoidance of the 
acid fumes as much as possible, will prevent the pe- 
culiar affection described. 

Ammonia has rarely caused disturbances of health 
in workmen brought into contact with it. When 
present in the air in large proportion it may give rise 
to serious symptoms. As it is often used to prevent 
the poisonous effects of mercury (q. v.) care should be 
taken that the proportion of the vapor in the air of 
the workroom should not exceed five per cent. 

Chlorine gas is very deleterious in its effects upon 
the workmen brought in contact with it in the various 
industries in which it is employed. Nearly one-half 
of the workmen engaged in the manufacture of chlori- 
nated lime, and in bleaching, become affected. 

The respiratory organs are principally affected. 
Pneumonia is exceptionally frequent. If an affected 

* Phila. Med. and Surg. Reporter, June 30, 1888. 



INDUSTRIAL HYGIENE. 171 

individual is predisposed to consumption the latter dis- 
ease is soon lighted up, and proves quickly fatal. The 
effect of the inhalation of concentrated chlorine is thus 
graphically described by Hirt. * ' The workman suffers 
from violent cough, and extreme dyspnea. In spite of 
the aid of the auxiliary respiratory muscles, the entrance 
of air to the lungs is insufficient, and the widely opened 
eyes, the pale bluish color, and the cold perspiration 
plainly show the mortal agony of the patient. With 
this the pulse is small, the temperature decreased. 
Soon after removal from the impregnated atmosphere, 
these phenomena disappear, and a few hours later, the 
workman is found enveloped in chlorine and hydro- 
chloric acid vapors in his accustomed place in the 
factory. The attacks seem to be but rarely fatal.' 

The constant inhalation of an atmosphere strongly 
impregnated with chlorine produces a cachectic appear- 
ance, bronchial catarrh, loss of the sense of smell, and 
a prematurely aged appearance. When this stage of 
chronic chlorine poisoning has been reached, complete 
health can rarely be re-established, even if the patients 
be entirely removed from the irritating atmosphere. 

Carbonic oxide is often present in the air of gas 
works, iron smelting works, and coke, or charcoal 
furnaces. The workmen engaged in these industries 
often suffer with diseases of the respiratory organs, 
digestive disturbances and general debility. Acute 
poisoning from carbonic oxide is relatively frequent, as 
already pointed out.f The prominent symptoms are at 
first violent headache, dizziness and roaring in the ears. 
These symptoms are followed by great depression of 
muscular power, nausea and vomiting. The vomited 
matters sometimes gain entrance into the trachea, and 
may thus produce strangulation. Unconsciousness, 

* Von Pettenkofer und Ziemsmen : Handbuch der Hygiene, etc. II Th. 4 Abth., 
p. 30. 

t See Chap. I, p. 1(1. 



172 TEXT-BOOK OF HYGIENE. 

convulsions and asphyxia rapidly succeed. Paralysis 
of the sphincters and of groups of other muscles are 
often present. The pulse is at first somewhat increased 
but soon becomes slower. The respiration is slow and 
stertorous, and the temperature falls from 3°-4° F. 
Glycosuria often occurs. If death does not occur in 
the attack, the patient frequently suffers from great 
depression, both physical and mental, loss of appetite, 
constipation, and various paretic conditions. 

The slow or chronic form of poisoning by carbonic 
oxide is characterised by headache, dizziness, slow 
pulse and respiration, nausea and sometimes vomiting 
and purging. Loss of memory, and diminution of 
mental activity are also said to be effects of the con- 
tinued inhalation of air charged with carbonic oxide. 

Carbonic acid ga,s is found as one of the constit- 
uents of the 'choke-damp' in mines. There is reason 
to believe that this is often the source of ill-health and 
death in miners, even where the symptoms of acute 
carbonic acid poisoning are not present. Hon. Andrew 
Roy* says that it ' is more insiduous than direct in its 
operations, gradually undermining the constitution 
and killing the men by inches.' Difficulty of respi- 
ration and weakness are the only symptoms calling at- 
tention to the pernicious effects of the gas. Where. 
however, the proportion of carbonic acid is large, acute 
poisoning occurs. This is manifested by the following 
symptoms : loss of consciousness and of the power of 
voluntary motion. In some cases there are convulsions: 
in others the above symptoms are preceded by difficult 
respiration, headache, depression, drowsiness, or psych- 
ical excitement. Recovery usually soon follows after 
removing the patient into a purer atmosphere. 

Vintners, distillers, brewers and yeast makers are 
said to suffer from the effects of carbonic acid occasion- 

* Third Annual Report State Mine Inspector of Ohio. Quoted in Buck's Hygiene 
and Public Health, Vol. II. , p. 243. 



INDUSTRIAL HYGIENE. 173 

ally, but serious results from this cause are probably 
very infrequent. 

Sulphuretted hydrogen when present in the air in 
large proportion, as for example, in privy vaults, cess- 
pools, and sewers may produce serious or fatal poison- 
ing. Formerly, when vaults were cleaned in the prim- 
itive way, these accidents were frequent, but at the 
present day, owing to improved methods of removing 
excreta, they are comparatively rare. The precautions 
advised in a preceding chapter* should be borne in mind 
when it is necessary for workmen to enter such places. 

The gases resulting from the putrid decomposition of 
organic substances, such as are found in tanneries, glue 
and soap works, and similar industries, are popularly 
believed to give rise to various diseases. There are no 
observations on record, however, to show that such is 
the case. As a matter of fact, the workmen engaged 
in the industries mentioned, seem to be exceptionally 
healthy, and to resist to a- considerable degree the rav- 
ages of phthisis and of epidemic diseases. 

Bisulphide of carbon is used in the arts princi- 
pally in the process of vulcanizing India rubber, and 
for extracting oils from seeds and fatty bodies. The 
constant inhalation of the vapor of bisulphide of car- 
bon produces a train of symptoms to which attention 
was first attracted by Delpech, in 1856. The symptoms 
have been observed frequently since that time. The 
following account is from Hirt :f 

' Some days, or even weeks or months after begin- 
ning this occupation, the workmen complain of a dull 
headache, becoming more severe toward evening. This 
symptom is soon followed by joint-pains, formication, 
and itching on various parts of the body. A more or 
less troublesome cough is present, but is not accom- 

* Chapter I., p. SI. 
t Op. oit., p. 66. 



174 TEXT-BOOK OF HYGIENE. 

panied by any characteristic sputa. The respiration is 
regular, the pulse somewhat increased in frequency. 
During this time certain individuals exhibit a marked 
exaltation of their intellectual powers, they talk more 
than formerly, and show an interest in matters in which 
they at other times show no concern. There is, how- 
ever, very rarely distinct mental disease. The sexual 
desires are increased in both sexes, menstruation be- 
comes irregular, and the urine possesses a faint odor of 
bisulphide of carbon. In this manner several weeks 
or months pass away. Very gradually the physical 
exaltation disappears, and a profound depression, mel- 
ancholy and discouragement succeeds, coupled with 
which is often loss of memory. Vision and hearing 
become less acute, and the sexual activity is completely 
destroyed. Anesthetic spots appear on various parts 
of the body, and numbness of the fingers prevent the 
workman from performing any fine work.' 

The disease never proves- fatal, but the normal con- 
dition of the individual is rarely re-established when 
the disorder has advanced to the extreme stages men- 
tioned. 

Iodine and bromine vapors when inhaled by work- 
men engaged in their preparation produce symptoms 
of poisoning which are sometimes very serious. Acute 
iodic intoxication consists in severe laryngeal irrita- 
tion, headache, conjunctivitis, and nasal catarrh. Oc 
casionally there is temporary loss of consciousness. 
Chronic iodic cachexia is often found among the work- 
men. In certain cases atrophy of the testicles and 
gradual disappearance of sexual power has been ob- 
served. In the manufacture of bromine, a form of 
bronchial asthma has been observed among those 
engaged in the establishment. No symptoms corre- 
sponding to those of chronic iodism have been observed 
among the workmen in bromine. 



INDUSTRIAL HYGIENE. 175 

The inhalation of the vapors of turpentine produce 
in a considerable number of those constantly exposed 
to them, diseases of the respiratory organs, beginning 
with cough, and, at times, resulting in consumption. 
In other cases derangements of the digestive organs, 
strangury and in a few cases bloody urine, have been 
observed. Nervous disturbances are rare after the in- 
halation of turpentine, and are limited to headache, 
roaring in the ears, or flashes of light before the eyes. 

Petroleum vapor when inhaled in a concentrated 
state produces symptoms similar to those of anesthet- 
ics. When exposed for a long time to diluted petro- 
leum vapor, workmen sometimes suffer from chronic 
pulmonary catarrhs, or from nervous derangements. 
Among the latter are disturbances of mental activity, 
loss of memory, giddiaess and headache. These symp- 
toms are however rare. More frequent are pustular or 
furuncular affections of the skin, which are due proba- 
bly to the direct irritant effect of the vapor. 

Lead-poisoning is one of the most characteristic 
diseases of artisans. It attacks workmen engaged in 
roasting and smelting of lead ores ; in the manufacture 
of white and red lead and of lead acetate and chromate; 
in type making, in painting, and in short in all occu- 
pations in which the workman is compelled to inhale 
the vapor or dust of lead, or in which it is conveyed 
in some manner to the digestive organs. It is believed 
also that it can be absorbed by the skin and produce 
its poisonous effects upon the economy. The average 
duration of life in the roasting and smelting furnaces 
is 41 years; of painters, as shown by table I., 45.07 years. 
Of the latter 75 per cent, are attacked by one of the forms 
of lead-poisoning, colic being most frequent. In the 
manufacture of white lead, more than half of the work- 
men suffer from lead-poisoning during the first year, 
lead colic being present in 60 per cent, of all the cases. 



176 TEXT-BOOK OF HYGIENE. 

In most sugar of lead manufactories 60 per cent, 
of all the operatives constantly suffer from some form 
of lead-poisoning. 

Poisoning has also been observed in workmen 
engaged in the manufacture of various pigments of 
which the acetate of lead is the base (e. g. lead chro- 
mates). Among type founders, the symptoms of lead- 
poisoning are not very rare, and even compositors 
sometimes suffer from lead-poisoning. In the latter 
case the lead must be absorbed through the skin in 
order to produce its effects. 

The various forms in which lead-poisoning affects 
the individual are the lead cachexia, manifested by 
loss of weight, discoloration of the skin, the character- 
istic blue line along the gums, diminution of the 
salivary secretion, a sweetish taste and offensive odor 
of the breath ; then lead colic, the features of which 
are well-known ; lead paralysis, the characteristic 'wrist 
drop,' which requires prompt and intelligent treat- 
ment, otherwise permanent atrophy of the affected 
muscles often takes place. Among other nervous man- 
ifestations of the poison is a painful affection of the 
lower extremities, attacking joints and flexor muscles, 
and remittent in character. At times anesthesia of 
the skin of the head and neck is present. In rare 
cases, serious mental derangement occurs. Other 
grave nervous lesions, such as the so-called saturnine 
hemiplegia and tabes are happily extremely rare among 
the workmen in the metal at the present day. 

Mercurial poisoning is frequent among the arti- 
sans who work in the metal. The smelters of the ore 
suffer severely and in a large proportion of the entire 
number employed. Their average age at death is forty- 
five years. Mirror makers suffer most severely of all 
the artisans who come in contact with the vapors of 
the metal. It is beyond question that the confinement 



INDUSTRIAL HYGIENE. 177 

in badly ventilated work-rooms is largely responsible 
for the poisonous effects of the metal upon this class. 
The special forms in which the poisonous effects are 
manifested in mirror makers are salivation, mercurial 
tremor, and nervous erethism, but in addition a very 
large proportion suffer from pulmonary consumption. 
It is stated that 71 per cent, of the total deaths among 
mirror makers (those who coat the glass with the mer- 
curial alloy) are from phthisis. 

Among women the symptoms are aggravated, and 
abortion frequently occurs. Of the children of women 
suffering from mercurial poisoning born living at term, 
65 per cent, die within the first year. 

Fire gilders, fulminate makers, and physical in- 
strument makers not infrequently suffer from the dele- 
terious effects of inhaling the vapor of mercury. Hat- 
ters are also liable to a considerable extent to the poi- 
sonous effects of the metal.* 

It has been found that upon sprinkling the floor of 
the work-room of mirror makers with aqua ammonia, 
so as to impregnate the atmosphere with ammonia, the 
bad effects of mercury on the system were markedly 
diminished. Care must be taken, however, not to use 
the ammonia to excess, otherwise the diseases caused 
by this agent may attack the workmen. 

Zinc or copper vapors, or possibly a combination 
of the two, given off from brass, which is an alloy of 
these metals, produces a peculiar train of symptoms 
known as 'brass-founder's ague.' The symptoms are 
described by Hirt, who has suffered from two attacks 
of the affection himself, as follows :f 'A few hours 
after attending the process of brass casting, one notices 
a peculiar, uncomfortable sensation over the whole 

* L. Dennis : Hatting, as Affecting the Health of Operatives. Report New 
Jersey State Board of Health, 1879.— Connecticut State Board of Health, 1883. 
t Op. cit., p. 122. 



178 TEXT-BOOK OF HYGIENE. 

body. More or less severe pains in the back, and gen- 
eral lassitude, canse a discontinuance of the ordinary 
occupation. While the pains appear now here, now 
there, and are extremely annoying, no changes in the 
pulse or respiration are noticeable. In a short time, 
however, usually after the patient has taken to the 
bed, chilliness comes on which soon increases to a de- 
cided rigor, lasting fifteen minutes or longer. In the 
course of an hour or less, the pulse now reaches a 
rapidity of 100-120 beats per minute. A tormenting 
cough, combined with a feeling of soreness in the chest 
comes on. In consequence of the repeated acts of 
coughing, the increasing frontal headache produces ex- 
ceeding discomfort. Soon, however, usually after a 
few hours, the height of The attack is reached, free 
perspiration indicates the stage of defervescence and 
during the gradual diminution of the symptoms, the 
patient falls into a deep sleep lasting several hours. On 
awaking, a slight headache and lassitude only remain 
as reminders of the attack. 

It is said that about 75 per cent, of the workmen 
in brass foundries are attacked by this affection; the 
attack is liable to be repeated at every exposure. 

A chronic form of poisoning is said to occur among 
zinc smelters, after following their occupation for ten 
to twelve years. It consists of hyperesthesia, formi- 
cation and burning of the skin of the lower extremi- 
ties, soon followed by alteration in the temperature 
and tactile sensation, and diminution of the muscular 
sense. Paresis of the lower extremities sometimes 
comes on. The disease has not yet been sufficiently 
investigated. 

Anilijt vapor is exceedingly poisonous when in- 
haled in a concentrated state.' Hirt describes an acute 
form which usually results fatally. -The workman 
falls suddenly to the ground, the skin is cold. pale, the 






[NDUSTRIAL HYGIENE. 179 

face is cyanotic, the breath has the odor of anilin, the 
respiration is slowed, and the pulse increased. The 
sensation, diminished from the beginning of the attack, 
gradually entirely disappears, and. death follows in a 
state of deep coma.'* There is a milder form which 
comes on after several days of exposure. It is char- 
acterised by laryngeal irritation, diminution of appe- 
tite, headache, giddiness, great weakness and depres- 
sion. The pulse is rapid, small and irregular. Respi- 
ration is little altered. There is decrease of sensibility 
of the skin. Convulsions may occur, but are usually 
of short duration. 

The chronic form of anilin poisoning is character- 
ised by three sets of symptoms : those affecting the 
central nervous system, the digestive tract, and the 
skin. Among the first are lassitude, headache, roar- 
ing in the ears, disturbances of sensation and motion 
of greater or less degree. 

The digestive derangements consist in eructations, 
nausea and vomiting. 

The cutaneous lesions are eczematous or pustular 
eruptions, and sometimes round, sharply circumscribed 
ulcers with callous borders. 

There is no trustworthy evidence that in the manufac- 
ture of anilin colors poisonous symptoms are produced 
in the workmen. 

II. — DISEASES J)I'E TO THE INHALATION OF IRRITATING 
OR POISONOUS Dl'ST. 

The inhalation of air containing particles of 
organic or inorganic matter has long been accepted as 
a cause of certain special diseases of artisans. The 
diseases so caused are usually limited to the pulmon- 
ary organs, and consist of acute and chronic catarrh, 

* Op, cit., p. 127. 



180 TEXT-BOOK OF HYGIENE. 

emphysema of the lungs, pneumonia, interstitial in- 
flammation of the lungs, the so-called fibroid phthisis 
or pulmonary cirrhosis. 

Coal dust is inhaled by coal miners, charcoal burn- 
ers, coal handlers, firemen, chimney sweeps, foundry- 
men, lead-pencil makers, etc. Chronic bronchial 
catarrhs are most frequent, while phthisis and emphy- 
sema are almost absent from the list of diseases affect- 
ing these workmen. The table on page 166 shows that 
the expectation of life of foundrymen, furnace-men, 
firemen and chimney sweeps is much below the aver- 
age. 

Metallic dust ,is inhaled by blacksmiths, nailers, 
cutlers, locksmiths, file-cutters, cutlery and needle pol- 
ishers, etc. While in thisclassof workmen casesof bron- 
chitis and pneumonia are relatively frequent, much the 
largest proportion suffer from phthisis. A table com- 
piled by Hirt shows that out of the total number of 
sick in the different classes of workmen the cases of 
phthisis were : 

62.2 per cent, for file cutters, 

69.6 " " " needle polishers, 

40.4 " " " grinders, 

12.2 " " " nailers. 

The Massachusetts table gives the average duration 
of life for blacksmiths at 53.26 years, of nail makers 
at 41.49 years, and of cutlers at 39.21 years. The 
needle polishers at Sheffield, as stated above, (page 168) 
have only an average duration of life of 30.66 years. 
In this work and that of grinding knives, scissors and 
similar articles, the metallic dust is mixed with mineral 
dust, (particles of silica from the grindstone). This 
mixture seems to be much more deleterious than metal- 
lic dust alone, as shown by the shorter average duration 
of life and the enormous percentage of cases of con- 
sumption. 



INDUSTRIAL HYGIENE. 181 

Mineral dust is inhaled by the workmen in a large 
number of different industries. The grinders in the 
ground-glass factories suffer most severely. Hirt found 
the average duration of life in grinders who began 
this occupation after their twenty-fifth year to be 42.50 
years, while in those who began at the age of fifteen, 
the average duration was thirty years. 

Mill stone cutting is also a very dangerous occupa- 
tion. Peacock* gives the average age at death of these 
workmen at 24.1 years. Stone-cutters generally, suf- 
fer frequently from phthisis, probably largely in conse- 
quence of the constant inhalation of the mineral dust 
produced during their work. The Massachusetts table 
gives the average age at death of these workmen at 
40.90 years, while Hirt's table gives a much lower age, 
namely 36.3 years. Poxters and porcelain makers are 
exposed to similar dangers from their occupation, but to a 
much less degree. The table on page 166 gives the aver- 
age age at death at 56.67 years, rather a high average. 

Slaters and workmen in slate quarries suffer in a 
large proportion of cases from chronic pneumonia, and 
die at a comparatively early age. 

Masons and carpenters have an average duration of 
life of 50.33 and 53.33 years respectively. One-third 
of all the diseases from which they suffer, affect the 
respiratory organs. 

Gussenbauer has reported a series of cases of a 
peculiar inflammatory affection of the diaphyses of 
the long bones, in the artisans who are engaged in the 
manufacture of pearl buttons. 

Gem finishers are exposed not only to the inhala- 
tion of dust, but to poisonous gases (carbonic oxide) 
and vapors, (lead). The proportion of sickness among 
them is very high. 

* Quoted by Mebkel, in Von Pettenkofer und Ziemssen. Handbuch der Hy- 
giene, IITh. 4 Abth. p. 197. 



182 TEXT-BOOK OF HYGIENE. 



VEGETABLE DUST. 



The workmen compelled to inhale vegetable dust 
are those who work in tobacco, cotton operatives, flax 
dressers, paper makers, "and weavers, wood turners, 
millers and laborers in grain elevators. 

Workmen in tobacco usually suffer within a few 
weeks after beginning work, from a nasal, conjunctival 
and bronchial catarrh which soon passes off, as the 
mucous membranes seem to become accustomed to the 
irritation. Nausea is also frequent at first, due prob- 
ably to the absorption of small quantities -of nicotin. 
Females exposed to tobacco dust usually suffer from 
digestive and nervous troubles. They are said also to 
abort frequently. Dr. E. S. Tracy,* as a result of his 
observations among the cigar makers in New York, 
states that the fecundity of these people is much less 
than the average. 325 families visited had only 465 
children, an average of 1.43 to each family. Dr. Tracy 
is inclined to attribute this to the' frequent abortions 
that occur among the females exposed to the inhalation 
of tobacco dust. According to the Massachusetts table, 
cigar making is an unfavorable occupation, the average 
age at death being 38.36 years. 

Cotton operatives, flax dressers, weavers, and work- 
men in paper mills are subject to various diseases of 
the respiratory organs. Coetsem, as long ago as 1836, 
described a peculiar pulmonary affection among cotton 
operatives, which he termed pneumonic cotonneuse. 
The observation does not seem to have been verified by 
others ; at all events, the author is unable to find any 
other record of a similar affection in the literature of 
the subject. Among weavers the mortality from phthi- 
sis is comparatively high. Among paper makers Hirt 
found an average duration of life of 37.6 years. The 

* Buck"? Hygiene and Public Health. Vol. II. p. 48. 



INDUSTRIAL H*YGIENE. 183 

people wlio sort rags are liable to a fatal infectious dis- 
ease, 'rag-sorter's disease,' (Hadernkrankkeit*) which 
resembles in all respects, and is probably nothing less 
than anthrax. N o cases have been reported in this coun- 
try, but as the importation of rags from abroad is carried 
on to a considerable extent, no apology is believed to 
be necessary for calling attention to it. The 'wool- 
sorter's disease,' to which attention has recently been 
called in England, is doubtless similar in its nature. 

Millers suffer in a large proportion of cases from 
pulmonary affections, especially bronchial catarrh and 
pneumonia. According to Hirt, 20.3 per cent, of all 
the diseases of these workmen are pneumonias, 9.3 per 
cent, bronchial catarrhs, 10.9 per cent, phthisis, and 
1.9 per cent, emphysema. The average duration of 
life, is 45.1 years. The Massachusetts table gives 57.14 
years, a Very much more favorable exhibit. 

The laborers in grain elevators are compelled to 
inhale a very irritating dust which causes acute and 
chronic catarrhs of the respiratory organs. Dr. T. B. 
Evans, of Baltimore, has reported a series of cases of 
catarrhal pneumonia in these workmen, which were 
characterised by some peculiar features. Brush ma- 
king, according to the statistics of Hirt, is a very dan- 
gerous occupation. Nearly one-half of the deaths 
among brush-makers are from phthisis, due, in great 
measure to the inhalation of the sharp fragments of 
bristles produced in trimming the brushes. In the 
Massachusetts table the average duration of life is 
given at 43.11 years. 

III. — DISEASES DUE TO THE ABSORPTION OR LOCAL AC- 
TION OF IRRITATING OR POISONOUS SUBSTANCES. 

Arsenic is used in the manufacture of green pig- 
ments, and for various other purposes in the arts. In 

* See Article by Sotka : Realencyclopredie d. ges. Heilk. Bd VI, p. 156. 



184 TEXT-BOOK OF HYGIENE. 

the preservation of furs, and in taxidermy it finds ex- 
tensive use. In the preparation of the pigment known 
as Paris green, the workmen are frequently entirely 
covered by a layer of the poisonous salt. The poison- 
ous symptoms occur in consequence of the absorption 
of the poison through the skin, or from its local action, 
and but rarely on account of inhalation of vapors or 
dust in which it is contained. The most marked 
symptoms are chronic gastric catarrh, superficial ero- 
sions in the mouth, dry tongue, thirst and a burning 
sensation in the throat. These symptoms may continue 
for months or even years and gradually produce a com- 
plete breaking down of nutrition and the vital powers. 
Violent itching skin eruptions, of an eczematous char- 
acter are not infrequent complications of the internal 
symptoms. 

Phosphorus produces two classes of effects in per- 
sons subjected to its influence. The milder effects are 
produced by the inhalation of the fumes of the sub- 
stance, and are limited to digestive disturbances, and 
diseases of the pulmonary organs. The severer symp- 
toms are only observed among the employes in match 
factories, and are due to the local action of the phos- 
phorus upon the tissues affected. 

The characteristic disease produced by phosphorus 
is a painful periostitis of the lower or upper jaw. The 
limitation of the affection to this locality is believed to 
be due to the action of the phosphorus dissolved in the 
saliva. The fact that the lower jaw with which the 
saliva comes more thoroughly in contact is most fre- 
quently affected, seems to indicate that this view is the 
correct one. The disease begins, on an average, five 
years after the beginning of the employment. Hirt 
estimates the proportion of employes in match factories 
attacked at 11 to 12 per cent. The first symptom of 
the disease is tooth-ache, soon extending to the jaw. 



INDUSTRIAL HYGIENE. 185 

The cervical glands swell up, the gums become reddened 
and spongy, abscesses form about the diseased teeth 
from which large quantities of thin, offensive pus are 
discharged. Examination with a sound reveals carious, 
nodulated bone. The cheeks become swollen, erysipel- 
atous, and may suppurate and discharge pus externally. 

The destruction of the soft tissues continues until 
resection of the jaw is finally undertaken and the 
disease checked by surgical interference, and removal 
of the patient from the influence of the pernicious 
substance. 

In the manufacture of quinine, a troublesome 
eczema is caused in about ninety per cent, of the 
employes.. , It seems to be due to emanations given off 
from the boiling solutions. It begins with intense 
itching, followed by swelling and the formation of 
vesicles, which soon burst and form crusts. There is 
considerable fever when the swelling is great. It is 
said that blondes are more frequently affected than 
those of dark complexion. The disease soon disappears 
if the work is given up. 

The workmen engaged in the manufacture of bichro- 
mate of potassium are said to suffer from an ulcera- 
tion of the nasal mucous membrane very similar to 
that already described as due to the vapors of hydro- 
chloric acid (p. 170). Rapidly spreading, deep ulcers 
are also said to form, if the bichromate comes in con- 
tact with abraded surfaces of the skin. 

The strong alkali handled by tanners frequently 
produces fissured eczemas of the hands which are pain- 
ful and often difficult to cure. 

The workmen in petroleum refineries frequently 
suffer from acneiform or furuncular eruptions. 

Among glass blowers, syphilis is frequently com- 
municated by an infected mouth-piece which is used 
by the men in turn. 



186 TEXT-BOOK OF HYGIENE. 

IV. — DISEASES DUE TO EXPOSURE TO ELEVATED OK VARI- 
ABLE TEMPERATURE OR ATMOSPHERIC PRESSURE. 

Cooks and bakers are exposed almost constantly to 
a high temperature, which produces an unfavorable 
influence upon health, and predisposes them to diseases 
of various kinds. The Massachusetts table shows that 
cooks have a much shorter duration of life than bakers, 
although the statistics of both trades are unfavorable. 

The prevailing diseases among cooks and bakers 
are rheumatism and eczematous eruptions, generally 
confined to the the hands, forearms and face. 

Blacksmiths, founders, and firemen suffer from the 
intense hea,t to which they are exposed, in addition to 
the inhalation of coal dust, as has already been pointed 
out (p. 180). The stokers in the engine-rooms of 
steamships suffer especially from the excessively high 
temperature to which they are subjected by their 
occupation. A form of heart-weakness, described by 
Levick as 'fireman's heart,' is prevalent among them. 

Sailors, farmers, coachmen, car drivers and team- 
sters are subjected to stress of weather, changes of 
temperature and storms. They suffer frequently from 
rheumatism, acute bronchitis, pneumonia and Bright' s 
disease. Car drivers are said also to suffer from pain- 
ful swelling of the feet, varicose veins and ulcers, and 
mild spinal troubles.* 

Sunstroke is not confined to any class of artisans, 
but persons who perform hard labor, especially in a 
confined atmosphere, suffer most frequently. 

The effects of compressed air on workmen in tunnels 
and deep mines has already been referred to.f The 
most serious symptoms occur, not when the individual 
is subjected to the increased pressure, but when the 
pressure is too rapidly diminished. 

* A. McL. Hamilton in Report Xew York Board of Health. 1OT3, p. 4J4. 
t Chapter I, p. 8. 



INDUSTRIAL HYGIENE. 187 

V. — DISEA8E8 DUE TO THE EXCESSIVE USE OF CERTAIN 
ORGANS. 

The prevalent belief that the over use of the intel- 
lectual faculties is a frequent cause of mental disease 
is not borne out by facts. Men and women who per- 
form an amount of mental work regarded by most 
persons as excessive, have in spite of this, a long 
duration of life. There are no exact statistics upon 
this subject, but Casper a half century ago made the 
following estimate of the average diiration of life 
among professional men : clergymen live (55 ; merchants, 
62.4; officials, 61.7; lawyers, 58.9; teachers, 56.9, and 
physicians, 56.8 years. In the table given on page 166, 
the figures are somewhat less favorable, although cor- 
responding in general with those of Casper. Hence, it 
is seen that of professional men, those whose occupa- 
tion compels the exercise of high mental powers, have 
a higher duration of life than any other class, except 
farmers and mechanics engaged actively out of doors. 
Those professional occupations only which necessitate 
a more or less irregular mode of life and frequent sub- 
jection to physical exhaustion and dangers from 
contagious disease, such as physicians and journalists, 
make an unfavorable showing in the statistics. The 
proposition may be laid down that it is not mental 
activity, however great, but mental worry that tends 
to the abbreviation of life. 

The occupation of a tea-taster is said to produce a 
peculiar nervous condition, manifested in muscular 
tremblings, etc., which compels the individual to give 
up the work in a few years. 

Persons who test the quality of tobacco, an occu- 
pation corresponding to that of tea-taster, are said to 
suffer often from nervous symptoms, which may include 
amaurosis and other grave affections. 



188 TEXT-BOOK OF HYGIENE. 

Those persons who are compelled to use their eyes 
constantly upon minute objects frequently suffer from 
defective vision. So engravers, watchmakers, seam- 
stresses, are liable to near sightedness, amaurosis, and 
irritation of the conjunctiva. Public speakers and 
singers frequently suffer from catarrhal, or even par- 
etic conditions of the throat, which usually disappear 
on relinquishing the occupation for a time. 

Telegraph operators and copyists suffer from a 
peculiar convulsive affection of the fingers, called 
'writer's cramp.' Performers on wind instruments 
are liable to pulmonary emphysema, on account of the 
pressure to which the lungs are frequently subjected. 
Boiler-makers often suffer from deafness, in conse- 
quence of their constant existence in an atmosphere in 
a state of continual violent vibration. The affection 
is generally recognized as 'boiler-maker's deafness.' 

VI. DISEASES DUE TO A CONSTRAINED ATTITUDE AND 

SEDENTARY LIFE. 

It is probable that the large mortality and rnorbil- 
ity rate of persons whose occupations keep them con- 
fined within doors are due, next to the defective ven- 
tilation, to the constrained attitude which most of 
them necessarily assume. Thus, carvers, book-binders, 
engravers, jewellers, printers, shoe-makers, book-keep- 
ers and cigar-makers all have a low average duration of 
life. It is found likewise that many of these artisans 
suffer most from pulmonary and digestive troubles : 
among the former being phthisis, and among the latter 
constipation, dyspepsia and hemorrhoids. 

VII. — DISEASES FROM EXPOSURE TO MECHANICAL VIO- 
LENCE. 

It will be seen by reference to the table on page 166. 
that all persons whose occupations involve an intimate 



INDUSTRIAL HYGIENE. 189 

contact with machinery, and in the pursuit of which 
accidents frequently happen, have a short duration of 
life. Persons liable to these dangers are machinists, 
operatives in factories, workmen in powder mills, bag- 
gage masters, brakemen, drivers, engineers, firemen, 
and other workmen on railroads. Aside from the dis- 
eases to which some of these classes are liable, in con- 
sequence of exposure to variable atmospheric condi- 
tions, the grave accidents to which they are so fre- 
quently exposed, render their occupations extremely 
dangerous. Brakemen on freight railroads, for exam- 
ple, are classed by insurance companies as the most 
hazardous 'risks,' and some companies refuse to take 
them at all. The table on page 166 tends to confirm 
the conclusion of the insurance companies for exclud- 
ing the class of 'students' which, for manifest rea- 
sons, cannot be used as a comparison, brakemen have 
the shortest average duration of life of all the occupa- 
tions noted in the table. 

[The student is referred for more complete infor- 
mation on the subjects considered in the foregoing 
chapter to the following works : 

L. Hirt: Die Krankheiten der Arbeiter. Eulenburg : Handbuch der 
Gewerbehygiene. Layet : Hygiene des Professions et des Industries]. 



CHAPTER X. 

MILITARY AND CAMP HYGIENE. 

The subjects embraced in this chapter can be most 
conveniently arranged under the following heads : — 

I. The Soldier ; his Training, Food, Clothing and 
Shelter. 

II. The Diseases to which Soldiers are especially 
liable. 

III. Civilian Camps. 

I. — THE SOLDI KI! AM) HIS TKAINTITG. 

The relations existing among different nations at 
the present time, require that a standing army of great- 
er or less number be maintained by each for the com- 
mon safety. This being the case, it needs no argument 
to prove that such an army should be composed of the 
best material available in order that it may be depend- 
ed upon for defense or offense when necessity demands 
that it should be called into active service. 

Hammond says with truth* that 'a weak, mal- 
formed, or sickly soldier is not only useless, but a pos- 
itive incumbrance' to an army. It is of the first 
importance, therefore, to exclude from the military 
service by a vigorous physical examination, all indivi- 
duals whose physical condition is defective, who are 
either suffering from, or predisposed to disease. 

The foremost authorities on military hygiene are 
agreed that no recruit should be enlisted for actual 
service before the twentieth year. In the English army 
the lowest age at present is nineteen years, in Germany 
twenty years, and in the United States twenty-one years. 

* Hygiene. Philadelphia, 1*<B. p. 1!'. 



MILITARY AM) (AMI' HYGIENE. 191 

The limit of age upward is forty-five years, except in 
cases of re-enlistments. The height of recruits must 
be at least five feet four inches ; minimum chest meas- 
urement 30 inches, with two inches expansion, and 
weight from 120 to 180 pounds. In the cavalry service 
the maximum weight is 165 pounds. Every recruit 
must be vaccinated before enlistment, 

The physical examination of recruits before en- 
listment must be made by a medical officer, whose 
decision, in the United States army, is definitive. In 
the German army the decision of the medical officer is 
not final, but subject to revision by the recruiting offi- 
cer, who may, if he sees fit, overrule the medical offi- 
cer's opinion and enlist a man who has been decided to 
be unqualified for the military service. In this, and 
various other respects, such as pay, rank, and effective 
power the Medical Staff of the United States army has 
many advantages over that of most foreign armies. 

11. — THE FOOD OF THE SOLDIER. 

The army ration of the United States, which is 
given below, approaches moderately near to the stand- 
ard quantity of food for a healthy male adult.'- The 
daily alloAvance for each soldier is as follows : 

12 oz. pork or bacon, or 
20 " fresh beef. 
16 " hard bread. 
. 2.4 " beans or peas, or 
1.6 " rice or hominy. 
1.6 " green coffee, or 
1.28 " roasted coffee, or 
.24 " tea. 
2.4 " sugar, 
.(i " salt. 
.04 " pepper. 
.04 qts. vinegar. 

Although the food allowance in the United States 
army is greater than in the British army, the medical 

* See Chapter ]TT. p. 59. 



192 TEXT-BOOK OF HYGIENE. 

officers of our army insist that the ration furnished is 
insufficient in quantity as well as not sufficiently varied 
to fulfil the demands upon it during active service. 

The money value of each of the above articles in 
the ration is fixed by the government and may be 
drawn instead of certain of the articles, and other 
articles of food purchased, and thus the dietary varied. 
The money so drawn constitutes what is known as the 
'company fund.' In the hands of a judicious com- 
manding officer, the company fund can be made a 
source of great benefit and comfort to the men, but 
that it is at times mismanaged or misapplied is well- 
known to army surgeons. 

Aside from the insufficient quantity of food fur- 
nished to soldiers, the cooking, especially in temporary 
camps, is often defective and causes digestive derange- 
ments and consequent innutrition. A good cook 
should be attached to every company. 

THE CLOTHING OF THE SOLDIER. 

The clothing of the United States soldier is toler- 
ably well adapted to its uses. It is generally well-made 
of good, serviceable material. The only exception that 
can be made with reason is that the foot-gear is not 
made to individual measure, and hence peculiarities of 
shape of the feet, cannot be taken account of. For- 
tius reason painful affections of the feet are of frequent 
occurrence, due to ill-fitting boots or shoes. 

When on a march, the soldier carries his extra 
clothing packed in a knapsack, and strapped upon the 
back. His blankets and great coats are rolled into a 
cylinder and strapped upon the knapsack. The weight 
each soldier has thus to carry, in addition to his arms 
and ammunition amounts to considerable. There is 
reason to believe that the pressure produced by the 
straps of a heavy knapsack, may cause not only dis- 



MILITARY AND CAMP HYGIENE. 193 

comfort, but actual disease. It is believed by many 
officers that the knapsack could be abolished with 
advantage, and the extra clothing rolled up in the 
blanket, or a water-proof sheet, and slung over the 
left shoulder. 

THE DWELLING OF THE SOLDIER. 

Soldiers are generally housed either in barracks, 
huts, or tents. The former are usually the habitation 
of the soldier in garrisons or permanent camps, while 
huts and tents are used for the purpose of sheltering 
the occupants of temporary camps. 

Barracks. — A military barrack is a one-story build- 
ing constructed of stone, wood, or iron, or a combination 
of these materials. The general plan of the barrack 
comprises a large room for the beds of the soldiers, one 
or more smaller rooms for the non-commissioned officers 
of the company or squad, and a wash-room. The sleep- 
ing room of the soldier is also his living or day room. 
It is evident therefore that sufficient air space and good 
ventilation must be provided, if the soldier' s health is 
to be maintained. In England, 600 cubic feet is re- 
commended for the initial air space. In the new barracks 
constructed in France according to the plans of M. 
Toilet, 770 cubic feet are allowed to each occupant. 

The special points of distinction of the system of 
Toilet, of which Schuster says that 'to it belongs the 
future of barrack construction' are : The frame of the 
building is of light iron ribs ; the interspaces are walled 
up with bricks or stone ; the roof is slate ; the ceiling 
is arched and all corners are rounded to prevent lodg- 
ment of dust. 

Ventilation is provided by openings in the walls at 
the edge of the roof for the entrance of fresh air, and 
ridge ventilators. In France, barracks have been 
built according to Toilet's system at Bourges, Cosne, 



194 TEXT-BOOK OF HYGIENE. 

Macon and Autun. Although occupied but a short 
time, it appears that the health of the soldiers remains 
much better in them, than in the barracks constructed 
on the old style. The system would seem also espe- 
cially to lend itself to the construction of hospitals. 
The wash and bath-rooms of the barracks should be so 
arranged as to encourage the soldier to cleanliness. 
Where the only lavatory in a barrack is, as the author 
has seen it, an open porch, men are not likely to spend 
much time in cold weather in washing their faces and 
hands, to say nothing of the rest of their bodies. 

The kitchen and dining room should be detached 
from the building serving as quarters; otherwise the 
odors of the cooking will pervade the building. 

The sinks or latrines should be placed at some dis- 
tance from the quarters and kitchen, and out of the 
line of prevailing winds. The writer has personal 
knowledge of a permanent military post within a few 
miles of the city of Washington, where, only a few 
years ago, (and for aught known to the contrary, at the 
present day) 'the rear', or place of depositing excre- 
ment, was about 75 yards distant from the kitchen and 
men's quarters, and directly in line, on the windward 
side, with the prevailing winds ! 

Before erecting any buildings it is of course neces- 
sary to endeavor to secure a clean and dry subsoil. 
Attention is called to the principles underlying the 
construction of dwellings, Chap. VI. 

Tents and Huts. — The tents used in the army are 
the hospital tent, the officers' wall tent, the A tent and 
the shelter tent, which is a modification of the last. 
The conical or Sibley tent, which was frequently seen 
in camps in the early part of the war between the 
States, has gone out of use. Soldiers give the prefer- 
ence to the shelter tent, which is light, each man's 
piece weighing only two pounds six ounces. Two 



MILITARY AJJD CAMP HYGIENE. 195 

pieces being joined together by buttons and button 
holes, and thrown over a ridge pole supported upon 
uprights, and the four corners fastened to pegs driven 
into the ground, form a tent 4 feet high, 5 feet 6 inches 
long, and having a spread at the base of between 6 and 
7 feet. Such a tent will form a comfortable shelter for 
two men, unless there should be strong winds or driv- 
ing rains, when the ends could be closed by blankets, 
brush, or an extra piece of shelter tent. The uprights 
and ridge are steadied by short guy ropes, one of which 
is furnished with each piece of the tent. 

In winter, especially when camps of more or less 
permanence are formed, the soldiers usually build log 
huts. The interstices between the logs are plastered 
up with mud or clay, and the roof is formed of canvas, 
generally several pieces of shelter tent joined together. 

The ground around the tent or hut should be 
trenched in order to carry off the rainfall. 

Cleanliness within and around tents or huts is of 
the first importance, and should be enforced in all 
camps by the proper authority. Military authorities 
have long since learned that in the matter of cleanli- 
ness of body, clothing or surroundings no dependence 
can be placed upon the soldier. Frequent and thor- 
ough inspections will alone secure proper cleanliness. 

CAMP DISEASES. 

The soldier' s profession has been aptly character- 
ised by Ruskin as 'the trade of being slain.' In the 
late war between the States, the total deaths of the 
Federal army numbered 279, 659 ; over ten per cent, of 
the entire number of enlistments. Of this number 
however, 186,216, or nearly two-thirds died from dis- 
ease, while the remaining 93,443, a small fraction over 
one-third, were killed in battle or died from the effects 
of wounds. 



196 TEXT-BOOK OF pYGIENE. 

Diarrhoea and Dysentery. — The most fatal dis- 
eases of camp life, especially in time of war, are diar- 
rhoea and dysentery. The statistics of the Federal army 
during the late war are given in the following table.* 

Table, I. — Total Deaths from Diarrhma and Dysentery in the U. S. Army, 
from May 1st, 1861, to June 3(Hh, 1866. 



WHITE TBOOrS, FROM 
MAT 1ST, 1861, TO ' 
JUNE 30th, 1866. 


COLORED TROOPS, FROM 

JT7LT 1ST. 1863. TO TOTAL. 
JUNE 30th, 1866. 


CASES. DEATHS. 


CASES. DEATHS. 


CASES. 


DEATHS. 


Acute Diarrhoea, 1,155,226 2,923 
Chronic Diarrhoea, 170,488 27,558 
Acute Dysentery, 233,812 4,084 
Chronic Dysentery, 25,670 3,229 


113,801 1,368 
12,098 3,278 
25,259 1,492 
2,781 626 

153,939 0,764 


1,269,027 
182,586 
259,071 
28.451 


4,291 
30,836 
5,576 
3,855 


Total, - - 1,585,196 37,794 


1,739,135 


44,558 



Owing to the fact that a considerable number of 
deaths were reported without assigning any cause, Dr. 
Woodward estimates the total number of deaths from 
the above diseases at 57,265, or, in the proportion of 
one death from diarrhoea and dysentery to three and 
one-half deaths from all diseases. Among the prison- 
ers of war held by the Confederate States in Anderson- 
ville prison, where tolerably complete records were 
kept, more than half the total deaths were from 
diarrhoea and dysentery, while the ratio of deaths to 
cases of the above two diseases was a fraction over 
seventy-six per cent. This frightful mortality from 
these two diseases, both in the prisons and among the 
armies in the field is principally due to the insanitary 
conditions surrounding the soldiers. Where the 
demands of hygiene were especially ignored ; where 
the food was bad in quality, or badly cooked; the 
water impure ; the soil polluted by excreta and other 
tilth ; where the men were exposed to stress of weather 
or to a paludal atmosphere — under these conditions, 
the above diseases of the intestines prevailed in their 
greatest extent and most fatal degree. 

* Medical and Surgical History of the War. Second Medical Volume, p. 2. 



MILITARY AND CAMP HYGIENE. 197 

Malarial Fevers.— The diseases due to the paludal 
poison are exceedingly frequent among soldiers 
encamped in malarial sections. During the civil war 
a very pernicious form of malarial fever received the 
designation of the locality in which it prevailed, and 
passed into the literature under the name of 'Chicka- 
hominy fever.' While malarial diseases were largely 
represented in the morbility reports during the war, 
the most serious results of the influence of the malarial 
poison were manifested in its effects upon patients sick 
with other diseases. Thus, typhoid fever, dysentery 
or pneumonia in a patient saturated with malaria was 
very much more serious than where this complication 
was absent. In the malarial regions in the interior of 
the country, the Mississippi Valley, and the Southern 
portion of the Western territories, malarial fevers are 
among the most prevalent camp diseases. Greater 
attention in locating camps, and care devoted to drain- 
ing the subsoil and maintaining a low level of the ground 
water, would doubtless result in improvement in the 
sickness-rate from this cause Hn the army. 

TypJioid Fever. — Typhoid fever is prevalent in 
camps and garrisons. As it may be propagated 
through the medium of infected discharges of typhoid 
patients, it will readily be perceived that neglect of the 
precaution of promptly disinfecting such discharges 
will almost inevitably result in spreading the disease, 
either by direct inhalation of effluvia from the patient 
or excreta, of pollution of the drinking water, or by 
contamination of the soil and subsequently of the 
atmosphere, by the intestinal discharges of the patient. 

PhtJrisis. — Especially among troops in barracks, 
phthisis is a very faual disease. Formerly the mortality 
from it was very heavy. Recent improvements in the 
hygiene of military posts, and greater care in selecting 
recruits have very greatly diminisned the death-rate 



198 TEXT-BOOK OF HYGIENE. 

from Y)litMsis among soldiers. Acute pulmonary 
affections, such as bronchitis, pleurisy and pneumonia 
are comparatively frequent in camps, being due to 
exposure. 

Typhus Fever and Scurvy. — These two diseases 
are at the present day comparatively rare as camp 
diseases. They break out, however, on every occasion 
when the laws of hygiene are violated by permitting 
overcrowding, overwork, and under-feeding. This is 
almost certain to occur during war, and hence, either 
fully developed scurvy, or a scorbutic taint are almost 
constant accompaniments of an army in the field. 
Among the allied armies in the Crimea, and in the 
Federal army during the war, scurvy and typhus fever 
claimed a considerable share in the mortality. 

Purulent Conjunctivitis. — This affection of the eyes 
is frequent among soldiers. It has even been supposed 
to be peculiar to soldier life, and has hence been termed 
'military ophthalmia.' It is contagious, and is prob- 
ably most often spread by the use of basins and towels 
in common. It is not merely annoying, but is a very 
grave affection, often causing perforation of the cornea 
and destruction of vision. The military surgeon 
should be on the lookout for it, and promptly isolate 
those infected. 

CIVILIAN CAMPS. 

The camps of civil life, whether established for 
the purpose of furnishing a refuge to the inhabitants 
of cities invaded by epidemic disease, yellow fever or 
cholera, or whether for religious purposes (camp meet- 
ings), or for recreation (hunting and fishing camps, 
etc.), should be organised and managed on the same 
principles as the military camp. The site should be 
selected with judgment— a clean, dry soil, abundance 
of wood and water. being requisites for a healthy camp. 



MILITARY AND CAMP HYGIENE. 190 

A superintendent, or officer of the day should be 
appointed, whose duty it is to carefully inspect the 
camp daily, and compel the prompt removal of all filth 
and offal from the immediate vicinity. Cleanliness of 
person, clothing and household is as important while 
'roughing it' in camp, as at home. Singularly this is 
very often forgotten by very intelligent people. 

The advantage of a well-administered refugee camp 
in case of yellow fever epidemics has been clearly 
shown by the brilliant success of the depopulation of 
Memphis during the epidemic of 1879. This experi- 
ment deserves imitation. 

[The following works on Military and Camp 
Hygiene should be studied in connexion with this 
chapter : 

Smart : The Hygiene of Camps; in Buck's Hygiene and Public Health, 
Vol. II. Wolzendokff : Armee-Krankeiten, in Realencyclopadie d. ges. 
Heilk, Bd. I, p. 489. Schuster: Kasernen, in Von Pettenkofer und 
Ziemssen'8 Handbuch der Hygiene, II.Th. 2. Abth. Cameron : Camps ; 
Depopulation of Memphis; Epidemics of 1878 and 1879. Public Health, 
Vol. V, p. 152.] 



CHAPTEK XI. 

MARINE HYGIENE. 

The melancholy accounts of the mortality from 
scurvy and typhus fever, which were formerly a part 
of the history of so many naval and passenger vessels, 
are happily now only records of the past. Occasion- 
ally, however, carelessness of the authorities, or of 
those responsible for the safety of people that 'go down 
to the sea in ships,' results in an outbreak of one or 
other of these diseases even at the present day. Thu^, 
for the fiscal year ending June 30, 1882, seventy-one 
cases of scurvy and purpura were reported by the 
medical officers of the Marine Hospital service. It 
appears that in only one instance (where six cases of 
scurvy had occurred on one vessel) was any investiga- 
tion ordered. A most superficial investigation showed 
that the law relating to the issue of lime-juice had 
been violated by the master of the vessel. No prose- 
cution resulted. Such facts indicate that the laxness 
in the enforcement of the regulations expressly made 
to prevent this fatal disease, may be again followed by 
outbreaks of greater or less gravity. 

THE SAILOR AND HIS HABITS. 

Although the sailor of the present day, especially 
in the naval service, is morally and intellectually far 
in advance of the 'Jack Tar' of former days, his life, 
both afloat and ashore, leaves much to be desired on 
the score of temperance, chastity, or purity of thought 
and speech. The life of a sailor in the United States 
Navy only thirty years ago, is thus graphically 
described by Medical Director A. L. Gihon:* 'A 

* Thirty Years of Sanitary Progress in the Navy. Annual address to the Naval 
Medical Sooiety, Washington, 1884. 



MARINE HYGIENE. 201 

motley crew, of whom Americans were a minority, and 
Englishmen, Irishmen, Northmen, and "Dagos" con- 
stituted the far greater part. Some had just returned 
from another cruise, having squandered or been robbed 
of their three years' pay by the landsharks, who 
cajoled them, only half sober, to the rendezvous, to be 
re-shipped, and thence to be herded, uncared for, on 
the receiving ship, still popularly termed the "guardo," 
until drafted on board the first sea-going vessel. All 
of them were in debt, most of them insufficiently clad, 
and unable to properly outfit themselves. The wretched 
herd, who were thus gathered from the purlieus of 
Water street, and North street, and South street, who 
at night were kennelled worse than dogs, by day fed 
like them — crouching on their haunches around greasy 
mess-cloths, cutting with jack-knives or pulling to 
pieces with grimy fingers the chuncks of "salt horse" 
and "duff" which made their daily fare, and which 
later in the cruise were both spoiled and scanty,' did 
not constitute an elevating subject for contemplation. 
'Stint of good food,' continues Dr. Gihon, 'was, 
however, not the chief of the old-time shell-backs' 
ocean trials. Fed like a brute, housed worse than one, 
however faithfully his labors were performed, there 
was for him only a long, dreary season of imprison- 
ment. For him there was no glad holiday on shore, 
when the land broke the monotony of the waste of 
waters. The officers might rush pell-mell out of the 
ship, but Jack could only strain his longing eyes upon 
the green fields or busy sea-ports. Notwithstanding 
the hardships of the voyage, the wretched food, and 
the outbreaks of disease, the crew were confined eight 
months on board ship, before "general liberty" was 
given, and then men and boys were sent on shore forty- 
eight hours to indulge in a mad revel, and to return 
crazed by rum, battered and bruised. The poor wretch 



202 TEXT-BOOK OF HYGIENE. 

first made ravenously hungry for dissipation by his en- 
forced confinement, was then expected to be temperate 
in the feast of indulgence offered him. and punished 
with vindictiveness if he sought to gorge himself with 
the poor semblance of pleasure. The "cat" had been 
abolished, but half a dozen boys strung upon the poop 
"bucked and gagged" ; half a dozen men triced up by 
their thumbs in the rigging ; each of the upright coffin- 
like " sweat boxes" with its semi-asphyxiated inmate ; 
the "brig" with its bruised and bloated crew in irons ; 
the main-hold with its contingent under hatches ; the 
sick-list swollen out of all proportion by inebriates, 
injured men and venereal cases — these were the fruits 
of the general liberty, which, within my professional 
life represented the sum of sanitary interest in the 
man before the mast.' 

Under such circumstances, little could be hoped for 
in the way of personal advancement of the crew. The 
labors, however, of the writer just quoted, and others 
among whom may be mentioned Wilson and Turner of 
the navy, and Woodworth, Hebersmith and Wyman 
of the Marine Hospital service, have drawn prominent 
attention to the unsanitary conditions of the sailor's 
life, and legal enactments have done much to elevate 
him to his proper rank as a human being, entitled to 
be treated with humanity at least. 

The seaman in the navy now receives an abundance 
of food, of good quality, usually well-cooked and 
decently served. The sailor in the merchant service, 
however, is still at the mercy of inhuman masters, who 
exact excessive service in return for insufficient food, 
abuse, ill-treatment and miserable lodging. 

THE PASSENGER. 

During the ten years from 1870 to 1879 inclusive, 
passenger vessels carried 1,561,126 passengers from 



MARINE HYGIENE. ZUd 

foreign ports en route to New York city. The mean 
duration of each voyage was 13.5 days. Out of the 
above number of passengers 2,518 died on the voyage, 
a death-rate of 1.61 per thousand for the voyage, and 
43.5 per thousand per annum. These figures accentu- 
ate the importance of sanitary improvement in passen- 
ger* vessels. The causes of this excessive mortality 
among emigrants, for it is almost exclusively among 
the passengers in the steerage, or 'between decks,' that 
the deaths occur, are over- crowding, improper feeding, 
defective ventilation, filthy personal habits, and ineffi- 
cient medical attention when sick. Although over- 
crowding is prohibited by statute, yet in every emi- 
grant vessel that arrived in New York during the first 
nine months of 1880, the number of passengers was in 
excess of the number allowed by law.* The shorter 
voyages and better sanitary conditions obtainable since 
steamships, especially those built of iron, have come 
into general use for the carriage of passengers, have 
very much reduced the mortality on ocean voyages ; 
but as just shown, the death rate is still excessively 
high, and many more improvements in the hygiene of 
emigrant vessels and of passengers are desirable. 

THE SHIP AS A HABITATION. 

As a habitation for the sailor and passenger, the 
ship demands the attention of the sanitarian. The 
principal points in which he is interested are the con- 
struction and ventilation of sleeping apartments, and 
the means of keejung the entire ship clean and free of 
water and impure air. 

The keel is the foundation of the ship. Branching 
out transversely from it are curved timbers, the ribs, 
which with the keel constitute the ship's frame. The 
ribs are covered externally and internally with plank - 

* TtrBNBR : Hygiene of Kmigrant Ships. Public Health, Vol. VI, p. 33. 



204 TEXT-BOOK OF HYGIENE. 

ing, and the spaces between the two coverings are the 
frame spaces, which are usually partly filled with filthy 
water, decomposing organic matter and foul air. The 
water collects in the bottom of the vessel, the bilge,* 
whence it is pumped out of the vessel. If the pump 
ing is neglected the bilge water becomes very off em i?e, 
and may cause disease in persons exposed to exhala- 
tions from it. The frame spaces are rarely ventilated, 
and hence are frequent sources of pollution of air on 
board vessels. 

The sleeping apartments of the crew of a merchant 
vessel are in the forecastle, usually a dark, damp, un- 
ventilated space in the bow of the vessel. On naval 
vessels the crew sleep on the berth-deck, which in the 
rarest instances is properly lighted and ventilated. 
The berth-deck is usually below the water-line. In all 
but the best class of vessels in the U. S. Navy, the air 
allowance for each man is less than 100 cubic feet. 

That a ship should above all be seaworthy, would 
seem to require no argument. It is self-evident that a 
leaky or rotten ship is at all times a highly dangerous 
habitation; yet crews and passengers are almost daily 
exposed to the perils of shipwreck in unseaworthy ves- 
sels, both in the mercantile marine and naval service. f 

'Dampness, dirt, foul air, and darkness,' says 
Gihon, 'are the direst enemies with which the sailor 
has to battle when afloat. 'J The first requisite for a 
healthy ship is dryness. 'A damp ship is an unhealthy 
ship,' says Fonssagrives, the greatest authority on na- 
val hygiene. From official reports it appears that the 
relative humidity of the berth-deck of vessels in the 
U. S. Navy is nearly always above 80 per cent., very 

* Hence called bilge water. 

+ Woodwortu . The Safety of Ships and those who travel in them. Public- 
Health, Vol. ril., p. 79 et. seq. 

X Naval Hygiene. 3d Ed. p. 38. 



MARINE HYGIENE. 205 

often rising to 90 and 95 per cent.* From the same 
source it is learned that the class of respiratory dis- 
eases furnished, with one exception, the largest amount 
of sickness in the navy during the year 1880. It is the 
concurrent testimony of all authorities in marine hy- 
giene that the vicious custom of daily drenching the 
decks with water, under the plea of cleanliness, is 
mainly responsible for this excessive moisture and its 
results. It is, therefore, one of the most important 
aims of marine hygiene to curtail this practice. Gihon 
recommends that the decks be coated with shellac to 
make them non-absorbent, and to wet them as rarely 
as possible, consistent with cleanliness. 

The ship should be clean and well ventilated. Ef- 
forts to keep a ship clean should not be expended upon 
the decks only; the occupied apartments below the 
hatches, the bilges and frame-spaces should receive 
especial attention from the sanitary inspector. It is 
frequently necessary to remove the flooring of the ves- 
sels in order to expose the accumulations of filth, which 
often make an infected ship synonymous with a dirty 
ship. To disinfect a dirty ship, steam forced into the 
hold under pressure, after the filth has been cleaned 
out, gives the most satisfactory results. Sulphur and 
chlorine are next in efficiency. Solutions of sulphate 
of iron or chloride of zinc may be poured into the 
bilges to prevent decomposition. 

It has been estimatedf that a minimum of 400 cu- 
bic feet of air-space, with facilities for thorough ven- 
tilation, should be allowed to each person aboard ship. 
It is safe to say that no vessel that floats gives to her 
passengers or crew the advantages of such conditions. 
Ventilation of the holds and bilges, and of the spaces 
between the timbers or ribs, ' intercostal ventilation, ' 

* Report of Surgeon-General of the Nayy, Washington, 1880. 
Hygiene of Emigrant Ships, Public Health, Vol. VI., p. 36. 



206 TKXT BOOK OK HYGIENE. 

as Turner calls it, is especially necessary. Any system 
of ventilation that does not contemplate the removal 
of the foul bilge air, is unworthy of consideration by 
the sanitarian. The system briefly described in chap- 
ter I., p. 27, seems to fully meet the demands. 

All parts of the vessel used as habitations or sleep- 
ing apartments should receive sufficient sunlight. At 
present, very few vessels have the quarters of the crew 
so disposed as to admit any sunlight at all. 

In the fire-rooms of steamships, especially on that 
class of naval vessels termed monitors, the tempera- 
ture often rises so high as would seem to render con- 
tinued existence in it impossible. Gihon states that 
the average temperature in the fire-room of the moni- 
tor Dictator, is 145° F., while Turner states that in a 
vessel the average fire-room temperature was 167° F.* 
The stokers frequently suffer from heat-stroke, and in 
a very large proportion of cases from heart disease. 

Lavatories and bathing facilities should be fur- 
nished on vessels for passengers and crew, and both 
should be compelled to keep their bodies and clothing 
clean. 

DISEASES ON SHIPBOARD. 

The diseases most liable to attack persons on ship- 
board are : Diseases of the respiratory organs, mala- 
rial diseases, digestive disorders, scurvy, typhus fever 
and skin diseases; and where the infection has been 
conveyed to the vessel by other persons, or by formites: 
yellow fever, cholera, small-pox and venereal diseases. 

Most of these affections can be prevented by proper 
measures of hygiene, as demanded by the conditions 
described in this chapter, or by the enforcement of the 
following regulations : 

Inspection of crews and passengers should be made 
compulsory before shipment. Persons suffering from 

* Buck's Hygiene and Public H«alth, Vol. II., p. 190. 



MARINE HYGIENE. 207 

contagious or infectious diseases should not be taken 
on board.* In order to make this provision effective, 
the history of the individual for two weeks prior to 
his application for shipment should be known to the 
inspecting officer. Passengers should possess bills of 
health from the local authorities at their homes, in 
order that the presence or absence of such diseases as 
small-pox, yellow fever, cholera or plague may be es- 
tablished by the inspector. Cholera has always been 
introduced into this country by immigrants. Everybody 
admitted to the ship should be vaccinated. During 
several years past a number of epidemics of small-pox 
have been traced to foreign immigrants who had not 
been properly vaccinated. 

Sailors should be submitted to a close personal 
inspection, and those suffering from venereal diseases 
should be rejected. The usual history of the cases is, 
that they soon go on the sick-list, and thus become an 
incumbrance instead of an aid on the vessel. These 
inspections should not be restricted to examinations 
for venereal diseases, but individuals incapacitated for 
the performance of a seaman's duties by any cause, 
should be rejected. This precaution would unques- 
tionably reduce the number of marine disasters directly 
traceable to deficiency in the working force on board 
vessels. In this country the services of the medical 
officers of the Marine Hospital service, might be made 
available to carry out these inspections. 

All sailors are liable to be placed in positions, 
where the prompt and accurate distinction of colors 
becomes necessary, hence all color-blind individuals 
should be rejected as seamen. The inability to dis- 
tinguish colors has often been the cause of grave 

* Gihon relates an instance where a man suffering from parotitis was transferred 
from the hospital of a receiving ship to a vessel going to sea. The disease was com- 
municated to more than seventy of the crew of the latter vessel. 



208 TEXT-BOOK OF HYGIENE. 

accidents at sea. Pilots can no longer obtain a license 
unless they satisfactorily pass an examination with 
reference to their ability to distinguish colors. 

[The following works contain more detailed infor- 
mation upon the subject treated in the foregoing 
chapter : 

A. L. Gihon : Practical Suggestions in Naval Hygiene, 3rd Ed., Wash- 
ington, 1873. T. J. Turner: Hygiene of the Naval and Merchant Marine; 
Buck's Hygiene and Public Health, Vol. II. Walter Wykan: Hygiene ot 
Steamboats on the Western Rivers. Report of Supervising Surg. Gen'l, M. 
H. Service for 1882. Annual Reports of the Surgeon General of the Navy 
for 1879, 1880 and 1881. Various papers by J. M. Woodworth, A. L. 
GraoN, T. J. Turner, Hebersmith, and A. N. Bell, in Public Health, 
Vols. I, III and VI.] 



CHAPTER XII. 

PRISON HYGIENE. 

Although the frightful mortality which formerly 
seemed a necessary accompaniment of the life of the 
convict has in the past half century markedly dimin- 
ished, the death rate among prisoners is still very 
greatly in excess of that of persons of the same age in 
a state of liberty. 

The observations and labors of John Howard, the 
' self-sacrificing philanthropist, in the latter half of the 
last century, and of Elizabeth Fry, in the first half of 
the present, directed the attention of legislators to the 
necessity of reform in the conduct of prisons and the 
treatment of prisoners. As a consequence of the labors 
of these reformers, the principles of prison discipline 
have been more fully developed during the past forty 
years by students of social science everywhere, and 
certain propositions have been formulated, which gov- 
ern, to a greater or less degree, legislation upon this 
subject. These propositions are, briefly, as follows : 

Prisoners must be properly classified, according to 
the nature of their crime and the duration of impris- 
onment. 

The two sexes must be strictly separated, and no 
opportunity given for intermingling while in the prison. 

Female prisoners should have female attendants 
exclusively. Mai e watchmen or other attendants should 
not be allowed in the female department of a prison. 

All prisoners must be kept employed at some man- 
ual labor, not necessarily for profit, but as an agency 
in the moral reformation of the convict. 

Punishments for infractions of discipline must not 
be excessive. 



I 

210 TEXT-BOOK OF HYGIENE. 

Efforts should be constantly made tending to the 
reclamation of criminals from their life of sin and crime. 

Due care must be taken by the State to preserve 
the health and life of the prisoner whom the State has 
deprived of liberty, and the opportunity of taking care 
of himself. 

A proper classification of prisoners, according to 
the degree of their criminality, the nature of the crime 
of which they have been convicted, or the length of 
time for which they have been sentenced, is now 
insisted upon by all students of prison discipline. As 
this subject more nearly concerns the social or legal 
relations of prisoners rather than their sanitary inter- 
ests, it is here passed over with a mere mention. 

The separation of the sexes, necessity of female 
attendants on prisoners of the same sex, employment 
of prisoners, and moral reformation of criminals like- 
wise belong especially to the social aspects of the ques- 
tion, and can find no discussion in this place. 

Regarding the remaining proposition, however, 
that which demands that the State shall exercise due 
care over the prisoner's health, it comprises a question 
that demands consideration in a text-book on hygiene. 

There is now a general concurrence of opinion that 
the State, in depriving any person of liberty, has no 
right to subject the individual suffering such depriva- 
tion to any danger of disease or death. In other 
words, the State has no right to abbreviate the life 
of the convict sentenced to prison. This proposition 
requires that the State see to it that the prisoner is 
well-fed, well-clothed and well-housed ; that he shall 
be well-cared for when sick, and that when his term of 
imprisonment expires, he shall be set at liberty, with 
only such effect upon his normal expectation of life as 
would result from the ordinary wear and tear of life 
upon his health. 






PRISON HYGIENE. 211 

It must be confessed, however, that the State is 
very far short of attaining this object. The mortality 
of convicts, even in the best regulated prisons, where 
especial attention is paid to the sanitary requirements 
of such buildings, is three times as great as among 
workmen in mines, confessedly one of the most danger- 
ous occupations. If insurance companies desired to 
insure the lives of prisoners, the companies would be 
obliged, in order to secure themselves against loss, to 
make the premium equivalent to an advance in age of 
twenty years. This means that a free person has as 
long an expectation of life at forty years as a prisoner 
has at twenty. Attention is again called to the fact, 
that the conditions in the most favorably situated and 
liberally managed prisons only are here considered. 
What the results are in other institutions, less favora- 
bly constructed and managed, will be apparent from 
the following brief statement. Mr. George W. Cable 
has shown* that in some of the prisons in the southern 
States, under the vicious lease system, the mortality is 
eight to ten times greater than in properly constructed 
and managed prisons elsewhere. In Louisiana, for 
example, 14 per cent, of all the prisoners died in 1881 ; 
and in the convict wood-cutting camps of the State of 
Texas, one-half of the average number so employed 
during 1879 and 1880 died. 

The mortality of prisoners is greatest in the 
second, third and fourth years of their confinement. 
In Millbank prison, in England, the death-rate per 
thousand was 3.05 in the first year, 35.64 in the second, 
52.26 in the third, 57.13 in the fourth, and 44.17 in 
the fifth years of imprisonment. 

The diseases most frequer-t among prisoners are 
pulmonary phthisis, and diseases of inanition, mani- 
fested by general dropsy. Consumption furnishes from 

* Century Magazine, February, 1884. 



212 TEXT-BOOK OF HYGIENE. 

40 to 80 per cent, of all deaths. When prisoners are 
attacked by acute febrile, or epidemic diseases (small- 
pox, cholera, dysentery), the mortality is much higher 
than among persons in a state of liberty. This fatality 
is due to an anemic or cachectic condition, which has 
been called 'the prison cachexia,' a depravement of 
constitution which yields readily to the invasion of 
acute diseases. 

Prisons should be built upon a healthy site, be 
properly heated and ventilated, have an abundant 
water supply, and facilities for a prompt and thorough 
removal of sewage. Baths and lavatories should be 
conveniently arranged, in order that thorough cleanli- 
ness can be enforced. 

The problem of feeding prisoners requires careful 
study. The food should not merely be sufficient in 
quantity and of good quality, but it should be well- 
cooked, and the bill of fare varied often, in order to 
avoid creating a disgust by an everlasting sameness. 
Prisoners often suffer from nausea and other digestive 
derangements, brought on solely by the monotonous 
character of the daily food. 

In work-shops and sleeping-rooms, dormitories or 
cells, the cubic air-space allowed to each inmate should 
not be less than 600 cubic feet, with proper provision for 
ventilation. The use of dark or damp cells as places 
of confinement is a relic of the barbarism in the treat- 
ment of convicts against which John Howard raised 
his voice so effectively in the last century. An abund- 
ance of sunlight should be admitted into every room 
in which a human being is confined. 

An important hygienic measure is daily exercise 
in the open air. It should be regularly enforced, and 
its modes frequently varied in order that it may not 
degenerate into a mere perfunctory performance. 



PRISON HYGIENE. 213 

Punishment for infractions of the prison-discipline 
should be inflicted without manifestation of passion, 
and only under the immediate direction of some official 
responsible to the State. It is questionable whether 
physical punishments, such as whipping, tricing up by 
the thumbs with the toes just touching the floor, buck- 
ing and gagging, and similar barbarities should be per- 
mitted under any condition. The permission to exer- 
cise such power is extremely liable to be abused by 
officials. The system of leasing out prisoners to pri- 
vate x )ai> ties, which prevails in some of the southern 
United States is vicious in the extreme, because it 
places the convict under the control of persons not 
responsible to the State, and in the majority of instan- 
ces, morally unfitted to wield the power of inflicting 
punishment. 

[The following works on Prison Hygiene and Prison 
Reform are recommended to the student : 

A. Bakk: Gefangniss-Hygiene,inVoN Pettenkofeb und Ziemssen's 
Handbuch der Hygiene, II. Th., 2 Abth. Trans. International Penitentiary, 
Congress, London, 1882. Trans. National Prison Association, Baltimore, 
1872. G. W. Cable: The uonvict Lease System in the Southern States, 
Century Magazine, February, 1884.] 



CHAPTER XIII. 

EXERCISE AND TRAINING. 

The healthy functions of the bodily organs can 
only be maintained by more or less constant use. A 
muscle, or other organ that is unused soon wastes away 
or becomes valueless to its possessor. On the other 
hand, trained use of the various organs makes them 
more effective for the performance of their functions. 
Thus, by practice, the eye can be trained to sharper 
vision, the ear to distinguish slight shades of sound, 
the voice to express varying emotions, the tactile sense 
to accurately appreciate the most minute variations of 
surface and temperature, and the hand to greater steadi- 
ness, or the performance of difficult and complex feats. 
The effectiveness of other organs, muscles, or groups of 
muscles can also be increased by systematic training, 
as is seen in the athlete and gymnast. 

PHYSIOLOGICAL EFFECTS OF EXERCISE. 

When a muscle contracts, the flow of blood through 
it is increased. Hence, contraction of a muscle, which 
consumes or converts stored-up energy, at the same 
time draws upon the circulation for a new supply of 
food-material to replace that consumed. The activity 
of the circulation through a muscle in action, results 
in increased nutrition and growth of the muscle. 

During muscular action, the activity of the respi- 
ratory process is increased. A larger quantity of air 
is taken into the lungs, more oxygen is absorbed by the 
blood, and an increased elimination of carbonic acid, 
takes place. The experiments of Pettenkofer and Yoit 
show that while in a state of rest, the average absorp- 
tion of oxygen in twelve hours amounted to 5,771.56 



EXERCISE AND TRAINING. 215 

grains, during work the amount reached 8,410.44 grains. 
For the same period the elimination of carbonic acid 
was: during rest, 8, 825. 25 grains, duringwork, 13,217.50. 

Upon the circulation, muscular exercise likewise 
exerts a manifest influence. The action of the heart is 
increased both in force and frequency, the arteries 
dilate, and the blood is sent coursing through the system 
more rapidly than when the body is at rest. 

Cutaneous transpiration is also promoted by mus- 
cular exercise. It is probable that in this way some 
of the effete matters in the system are removed, being 
held in solution and carried through the skin in the 
perspiration. 

PHYSICAL TRAINING. 

There can be no question that systematic training 
of the muscles has a favorable influence upon health 
and longevity. Persons who are actively engaged in 
physical labor, other things being equal, are healthier, 
happier, and live longer than those whose occupation 
makes slight demands upon their muscular system. 
In default of an active occupation the latter class is 
forced, if good health is desired, to adopt some form of 
exercise which will call the muscles into activity. 

The principal methods of physical training are, 
walking or running, rowing, swimming, and the various 
in-door gymnastic exercises. Rapid walking or run- 
ning is one of the best methods of physical exercise, 
for not only are the muscles of the legs and thighs 
developed, but the capacity of the chest is increased — 
one of the principal objects of physical training. By 
combining walking with some form of in-door gymnas- 
tics, such as practice with the dumb-bells, Indian clubs, 
rowing machine, or pulley weights, nearly all the good 
effects of the most elaborate system of training can be 
obtained. 



210 TEXT-BOOK OF HYGIENE. 

For the gymnastic exercises, various forms of use- 
ful labor may be substituted with advantage, such as 
wood-chopping or sawing, or moderate work at any 
physical labor. 

The scheme of studies in our public school system 
should include physical training for both sexes. This 
is a question not merely of individual, but of national 
importance. Weak and unhealthy children are not 
likely to grow up into strong and healthy men and 
women ; and the latter are necessary for the perpetuity 
of the nation. The time seems to have arrived when 
physical education should no longer be looked upon as a 
whim of unpractical enthusiasts and hobby-riders, but 
as an indispensible element in every school curriculum. 

There is a tendency among instructors in physical 
training to make their systems too complicated, or 
dependent upon expensive or cumbersome apparatus. 
This is to be deprecated. All the muscles of the body 
can be called into action by very simple exercises, easily 
learned, and readily carried out. 

An important preliminary to all methods of train- 
ing, is a thorough physical examination of the pupil 
by a competent physician, in order to determine 
whether certain exercises are allowable. For example, 
in all organic heart affections, exercises of a violent 
character must be interdicted. A boy or man with val- 
vular disease of the heart, cannot run, row or swim 
with safety. The organ is easily overtasked in this 
condition and liable to fail in its function. 

One of the simplest and best methods to cause the 
pupil to assume a correct position of the body, and to 
acquire ease and grace in his movements, is to teach 
him the 'setting up,' as practiced in the U. S. army.* 

In walking, a free, swinging step should be ac- 
quired, with the head erect, shoulders thrown back 

* Upton's Infantry Tactics. School of the Soldier, lesson I. 



EXERCISE AND TRAINING. 217 

and chest well to the front, the whole body from the 
hips upward inclining slightly forward. The clothing 
should be loose around the upper part of the body, in 
order not to interfere with the freest expansion of the 
chest, and to give the lungs and heart ample room for 
movement. Even in-door gymnastic exercises alone, 
when practiced under intelligent supervision, will 
accomplish very favorable results, as shown by the fol- 
lowing table: 

TABLE I. 

Showing average state of development on admission to gymnasium ; average state 
of growth and development after six months' practicing two hours a week, and 
average increase daring that time. (Bowdoin College Gymnasium, under Dr. 
JD. A. Sargent. 200 students from the classes of 1873-77, inclusive. Average 
age, 18.3 years )* 

ON ADMISSION. 

Height, - - 5 ft. 8 in. 

Weight, ? 135 lbs. 

Chest (inflated), 35 in. 

Cliest (contracted,) 32J in. 

Forearm, - 10 in. 

Upper arm (flexed,) 11 in. 

Shoulders (width), 15-J in. 

Hips, - - 3Uin. 

Thigh, - 19+ in. 

Calf - - 12£in. 



OVER-EXERTION. 

However necessary for the preservation of health 
physical exercise may be, over-exertion should be care- 
fully avoided. Over-strain and hypertrophy of the 
heart are often results of excessive exertion. Dr. Da 
Costa has described a form of 'irritable' and weak 
heart occurring especially among soldiers, which he 
has clearly traced to over-exertion. Severe labor and 
violent athletic exercises have been followed by like 
serious results. Long distance pedestrianism has fur- 
nished within recent years quite a number of individ- 

* Apparatus used: Weights, 10-15 lbs.; Dumb-bells. 2)^ lbs.; Indian Clubs, 3}i 
lbs.; Pulleys. 



months' practice. 


AVERAGE INCREASE. 


5 ft. 8 i in. 


iin. 


137 lbs. 


2 lbs. 


36f in. 


l|in. 


33 in 


Jin. 


lOf in. 


fin. 


12 in. 


lin. 


16i-in. 


i in. 


33| in. 


2Jin. 


21 in. 


Hin. 


13iin 


i in. 



218 TEXT-BOOK OF HYGIENE. 

uals who were broken down in health by the excessive 
strain on the physical organisation involved. Cardiac 
strain is not infrequent among this class. 

Spasm, paralysis, or atrophy of muscles sometimes 
results, when these are exhausted by uninterrupted or 
excessive exercise. This effect is shown by writer's 
and telegrapher's cramp, and similar affections. For 
these reasons it is important that both exercise for 
health and actual work should be so regulated as to 
conduce to the individual's benefit, and not to his 
detriment. 

[On the subjects embraced in this chapter the fol- 
lowing works may be studied with advantage : 

A Bratton Ball: Physical Exercise, in Buck's Hygiene and Pub- 
lic Health, Vol. I. Wm. Blaikie : How to Get Strong and How to Stay So. 
A. Maclaren : Training in Theory and Practice.] 



CHAPTER XIV. 

BATHS AND BATHING. 

The most important sanitary object of bathing is 
cleanliness. A secondary object of the bath is to 
stimulate the functions of the skin, and to produce a 
general feeling of exhilaration of the body. Baths 
are used of various temperatures. A cold bath has a 
temperature of from 40° to 75° (Fahr.); a tepid .bath 
from 75° to 85°; a warm bath from 85° to 100°; and a 
hot bath from 100° to 110.° 

Tepid, warm, or hot baths are used principally as 
cleansing agents, or as therapeutic measures. They 
cause dilatation of the cutaneous capillaries, diminish 
blood-pressure, and reduce nervous excitability. The 
hot bath is also a method for restoring warmth to the 
body in certain cases of shock, or to remove the imme- 
diate effects of injurious exposure to low temperature. 

The so-called Russian and Turkish baths, so popu- 
lar in the larger cities of this country, are modifications 
of vapor and hot-air baths, or rather combinations of 
these with cold baths. The Turkish bath is especially 
to be recommended for its depurative and invigorating 
effects. 

Cold baths are used not merely for their cleansing 
effects, but principally for their stimulating effects 
upon the system. When first plunging into a cold 
bath, there is usually a momentary shock, the respira- 
tion is gasping, and the pulse is increased in frequency. 
These symptoms disappear in a few moments however, 
and reaction follows. To a healthy person a cold bath 
is a delightful general stimulant, removing the sense 
of fatigue after physical exertion, and causing an 
extremely refreshing sensation throughout the body. 



220 TEXT-BOOK OF HYGIENE. 

As a therapeutic measure, the cold bath has a wide 
field of usefulness. For the reduction of the bodily 
temperature in fevers, and inflammatory diseases, and 
especially in heat-stroke, it is more prompt and 
effective than any other agent at the command of the 
physician. 

Sea Bathing. — The most stimulating form of the 
cold bath is doubtless the salt-water bath as taken at 
the sea- shore. The revulsive effect of the impact of 
the waves and breakers upon the skin, and the stimu- 
lation due to the saline constituents of the sea- water 
heighten the invigorating effects of the simple cold 
bath. The beneficial results of sea-bathing are, how- 
ever, not entirely due to the bath, but are to a great 
degree dependent upon the bracing air of the sea-shore, 
absence of the care and anxieties of business, and the 
temporary change in food and habits that a residence 
at the sea-side involves. Nevertheless, salt-water 
baths are more stimulant to the skin than those of 
simple water, and part of the good effects of sea-bath- 
ing can often be obtained from a salt-water bath taken 
at home. The following mixture of salts dissolved in 
about thirty gallons of water for one bath, makes a 
fairly good substitute for a sea-bath : 

Take of Chloride of Sodium (common salt), - 9 lbs. 
Sulphite of Sodium (Glauber's salt), - 4 " 
Chloride of Ca'cium, ----£•" 
Chloride of Magnesium, - - - - 3J " 

There is a prevalent popular belief that it is 
extremely dangerous to enter a cold bath when heated 
or perspiring. The author is of opinion that this 
belief is erroneous. The stimulant and bracing effects 
of the cold bath are most manifest if it be taken while 
the individual is very warm or bathed in perspiration. 
Several years ago the author made a series of observa- 
tions upon himself to determine the effects of the cold 
bath when the body was very warm. Every afternoon 



BATHS AND BATHING. 221 

a free perspiration was provoked by a brisk walk of 
about a mile and a half in the sun. As soon as the 
clothing could be cast off, and while the body was still 
freely perspiring, a plunge was taken into a fresh-water 
bath of about 60° Fahr. IS T o ill results followed; on 
the contrary, the sensation immediately following the 
bath, and for six or eight hours afterward was exceed- 
ingly pleasant. The health remained perfect, and the 
weight decidedly increased during the two months the 
practice was continued. There is probably no danger 
to a healthy person in this practice, but it is considered 
advisable to immerse the head first ('take a header'), 
to avoid increasing the blood-pressure in the brain too 
greatly, which might result if the body were gradually 
immersed from the feet upward. 

RULES FOR BATHING. 

The following series of rules have been issued by 
the English Royal Humane Society, and are well worth 
observing by bathers: — 'Avoid bathing within two 
hours after a meal. Avoid bathing when 'exhausted by 
fatigue, or from any other cause. Avoid bathing when 
the body is cooling after perspiration. Avoid bathing 
altogether in the open air, if, after having been a short 
time in the water, there is a sense of chilliness, with 
numbness of the hands and feet ; but bathe when the 
body is warm, provided no time is lost in getting into 
the water. Avoid chilling the body by sitting or 
standing undressed on the banks, or in boats, after 
having been in the water. Avoid remaining too long 
in the water, but leave the water immediately if there is 
the slightest feeling of chilliness. The vigorous and 
strong may bathe early in the morning on an empty 
stomach. The young and those who are weak had 
better bathe two or three hours after a meal ; the best 
time for such is from two to three hours after breakfast. 



WZ TEXT-BOOK OF HYGIENE. 

Those who are subject to giddiness or faintness, or 
suffer from palpitation or other sense of discomfort at 
the heart, should not bathe without first consulting 
their medical adviser.' 

To these instructions may properly be added that 
a warm or hot bath should be avoided, if the person is 
liable to exposure to cold within a few hours after the 
bath; that women should, as a rule, not take a cold 
bath while menstruating, or during the.last two months 
of pregnancy, and that persons suffering from organic 
heart disease should especially avoid surf -bathing. 

After bathing, the body should be thoroughly 
dried with soft towels, otherwise eczematous eruptions 
are liable to follow in the parts subject to friction from 
opposing surfaces of the skin, as in the groins, the 
perineum and inner surface of the thighs, the armpits, 
or the under surface of the breasts, in women in whom 
these organs are large and pendant. 

Friction of the skin with a coarse towel, or so-called 
'flesh brush' is a popular practice, but is not to be 
universally commended. The hyperemia of the surface 
thus produced may sometimes induce cutaneous 
diseases (erythema, eczema, psoriasis,) in those predis- 
posed. 

DANGEKS OF COLD BATHING. 

One of the most serious dangers of cold bathing, 
but which is not sufficiently appreciated, is the ten- 
dency to nausea and vomiting if the stomach contains 
much food. There can be no doubt that many of the 
cases that are called 'cramp,' and which frequently 
result in drowning, are due to this cause.* 

Cramps of various muscles sometimes occur, 
rendering the bather helpless, and if in deep water he 
is liable to drowning before assistance can reach him. 

* So far as the author is aware, Db. John Morris, of Baltimore, first called 
especial attention to this source of danger. 



BATHS AND BATHING. Wld 

HOW TO RESTORE THE APPARENTLY DROWNED. 

In drowning, death takes place by asphyxia. The 
respiration is arrested by the submersion of the head, 
the carbonised blood gradually poisons the system, and 
the heart ceases to beat. So long as the heart will 
react to its appropriate stimulus, the person may be 
restored to life. The first thing to do therefore after a 
recently drowned person is taken out of the water, is 
to attempt to re-establish the arrested respiration. 
Several methods are in use for this purpose. Sylves- 
ter's is one of the simplest. It is as follows : 

The body being placed on the back (either on a flat 
surface, or better, on a plane inclined a little from the 
feet upward), a firm cushion, or similar support (a coat 
rolled up will answer) should be placed under the 
shoulders, the head being kept in a line with the trunk. 
The tongue should be drawn forward to raise the 
epiglottis and uncover the wind-pipe. The arms should 
be grasped just above the elbows and drawn upward 
until they nearly meet above the head, and then at 
once lowered and replaced at the side. This should be 
immediately followed by pressure with both hands 
upon the belly, just below the breast-bone. The pro- 
cess is to be repeated fifteen to eighteen times a minute. 

Several years since the Michigan State Board of 
Health published a method which is comprehensive, 
effective, easily understood and readily carried out. 
This method has also been adopted by the U. S. Life 
Saving Service. The following are the details of the 
'Michigan method': 

Rule 1. — Remove all obstructions to breath- 
ing. Instantly loosen or cut apart all neck and waist 
bands; turn the patient on his face, with the head 
down hill; stand astride the hips with your face 
toward his head, and locking your fingers together 



224 TEXT-BOOK OF HYGIENE. 

under his belly, raise the body as high as you can 
without lifting the forehead off the ground, and give 
the body a smart jerk to remove mucus from the throat- 
and water from the windpipe, hold the body suspended 
long enough to slowly count one— two— three— four— jive, 
repeating the jerk more gently two or three times. 

Rule 2. — Place the patient on the ground face 
downward,, and, maintaining all the while your position 
astride the body, grasp the points of the shoulders by 
the clothing, or if the body is naked, thrust your 
fingers into the armpits, clasping your thumbs over the 
points of shoulders, and raise the chest as high as you 
can without lifting the head quite off the ground, and 
hold it long enough to slowly count one — two — three. 
Replace him on the ground with his forehead on his 
flexed arm, the neck straightened out, and the mouth 
and nose free ; place your elbows against [the inner 
surface of] your knees and your hands upon the sides 
of his chest over the lower ribs and press downward and 
inward with increasing force long enough to slowly 
count one — two. Then suddenly let go, grasp the 
shoulders as before, and raise the chest ; then press 
upon the ribs, etc. These alternate movements should 
be repeated ten or fifteen times a minute for an hour 
at least unless breathing is restored sooner. Use the 
same regularity as in natural breathing. 

Rule 3. — After breathing has commenced, restore 
the animal heat. Wrap him in warm blankets, apply 
bottles of hot water, hot bricks, or anything to restore 
heat. Warm the head nearly as fast as the body, lest 
convulsions come on. Rubbing the body with warm 
cloths or the hands and slapping the fleshy parts 
may assist to restore warmth and the breathing also. 

If the patient can surely swallow, give hot coffee, 
tea, milk, or a little hot sling. Give spirits sparingly, 
lest they produce depression. 



BATHS AND BATHING. 225 

Place the patient in a warm bed, and give him 
plenty of fresh air. Keep him quiet. 

BkwakeI Avoid delay. A moment may turn the 
scale for life or death. Dry ground, shelter, warmth, 
stimulants, etc., at this moment are nothing — artificial 
breathing is everything — is the one remedy — all others 
are secondary. Do not slop to remove wet clothing. 
Precious time is wasted, and the patient may be fatally 
chilled by exposure of the naked body, even in summer. 
Give all your attention and efforts to restore breathing 
by forcing air into, and out of, the lungs. If the 
breathing has just ceased, a smart slap on the face, or 
a vigorous twist of the hair will sometimes start it 
again, and may be tried incidentally. Before natural 
breathing is fully restored, do not let the patient lie on 
his back Unless some person holds the tongue forward. 
The tongue by falling back may close the windpipe and 
cause fatal choking. 

Do not give up too soon: you are working for life. 
Any time within two hours you may be on the very 
threshold of success without there being any sign 
of it.* 

PUBLIC BATHS. 

In all large cities and towns, provision should be 
made for free public baths, conducted under official 
supervision, and for the especial use and benefit of the 
poorer classes. General cleanliness is not merely a 
factor in the preservation of the public health, but 
there is good reason to believe that the cause of good 
order and decency would likewise be promoted, by fur- 
nishing the public the means of easily and cheaply 
keeping clean. Several of the larger cities in the 
country have established public baths upon a limited 

* Report Michigan State Board of Health, 1874, p. 01-99. 



226 TEXT-BOOK OF HYGIENE. 

scale, but it is reported that in one of them — Phila- 
delphia — they have been discontinued from economical 
motives. 

[Many valuab'e hints on sea-bathing can be obtained from the little work 
on Sea Air and Sea-Bathing, by Dr. Jno. H. Packard, published in thf- 
series of American Health Primers.] 



CHAPTER XV. 

CLOTHING. 

The primary object of clothing is the protection of 
the body against injurious influences of heat, cold and 
moisture. Secondarily, the moral sense of civilised 
communities demands that the nude human body shall 
not be exposed in public. Hence, there are moral as 
well as sanitary reasons for the wearing of clothing ; 
only the latter can be considered in this x'lace. 

Bodies radiate or absorb heat, accordingly as they 
are surrounded by a medium having a lower or higher 
temperature than themselves. In order, therefore, to 
avoid chilling of the human body, if exposed to a tem- 
perature below 98° Fahr., clothing must be worn to 
prevent or retard radiation of the body-heat. Expos- 
ure of the unprotected body to a low temperature 
would not merely cause chilling of the surface, owing 
to the rapid loss of heat, but would incidentally pro- 
duce congestion of internal organs, by causing con- 
striction of the superficial capillaries. 

Clothing is also worn as a protection against great 
heat. The head, especially, needs protection from the 
sun's rays. 

CLOTHING MATERIALS. 

The materials from which clothing is made are, 
principally, cotton, linen, wool, silk, and the skins of 
animals. Of these, probably the most universally used 
is cotton. It is cheap, durable, does not shrink when 
wet, absorbs little water, and conducts heat readily. 
It is, therefore, especially valuable for summer gar- 
ments, allowing rapid dissipation of the body heat and 
evaporation of the perspiration. 



228 TEXT-BOOK OF HYGIENE. 

Linen conducts heat even better than cotton, and 
is for this reason largely used for summer clothing. 
Its principal advantage over cotton is, that it is more 
durable, and less harsh to the skin. 

Wool absorbs water readily and is a bad conductor 
of heat. It is, therefore, valuable as a winter garment, 
retarding radiation from the body. Woolen under- 
garments should be worn at all seasons, in order to 
prevent too rapid changes of the surface, and so invok- 
ing diseases depending upon chilling of the body. 
Clothing of pure wool (flannels), are liable to irritate 
the skin of some persons. A mixture of wool and 
cotton, known as ' Saxony wool, ' is softer and less irri- 
tating, and makes a serviceable substitute for pure wool. 

Silk is often used for undergarments. It is light, 
soft, and a bad conductor of heat. 

The skins of animals, with the fur on, are often 
used for outside clothing. They furnish great protec- 
tion against severe cold. The skin is impermeable to 
v/ind and rain, while the thick, pilous covering of fur 
retards to a very great degree the radiation of heat. 
In British America, the northwestern States and Ter- 
ritories and in the arctic regions, the use of skin cloth- 
ing is necessary for comfort. 

As a protection against moisture (rain and snow), 
rubber cloth is used for overcoats, etc. While it serves 
effectually in keeping out the rain, it prevents evapor- 
ation of the perspiration, increasing the liability to 
chill, and rendering the person wearing it very uncom- 
fortable, except in cold weather. 

Leather is used almost exclusively in the manufac- 
ture of foot-wear. It is sometimes used, however, for 
other articles of clothing, such as coats, trowsers, etc. 
It furnishes most effective protection against cold. 

The color of the clothing is of great importance. 
Exposed to the sun, white wool or silk absorbs very 



CLOTHING. 229 

little more heat than linen or cotton, bnt the same 
material, of different colors, when exposed to the sun's 
rays, exhibits marked differences in absorptive capac 
ity. The following table shows the results of some 
experiments of Pettenkofer. The material used was 
cotton shirting of the colors named : 



White absorbed 


. 


100 heat units. 


Light Sulphur Yellow 


absorbed 102 


Dark Yellow absorbed 


. 


140 


Light Green absorbed 




155 


Turkey Red absorbed 


- 


165 


Dark Green absorbed 


. 


168 


Light Blue absorbed 


. 


198 


Black absoibed 


- 


2l8 



When protected from the sun's rays, however, the 
material becomes important and the color is of little 
consequence. Wool, being a bad conductor of heat, 
retards radiation from the body, and is hence the best 
material for winter clothing. 

Gases and vapors, probably also disease-germs, 
are absorbed by clothing and may be thus conveyed 
from place to place. It has been found that woolen 
clothing possesses this power of absorption to a much 
greater degree than linen or cotton. The bad odor of 
a crowded room or of tobacco smoke frequently clings 
to woolen garments for days, although they may be 
exposed constantly to the air during the interval. It 
would be advisable, therefore, that physicians attend 
ing infectious diseases, hospital attendants and nurses, 
should wear linen or cotton clothing instead of woolen. 

Clothing should be made to fit properly. It should 
not restrain muscular movements, obstruct the circula 
tion or compress organs. Hence, corsets, belts and 
garters are to be condemned. It is a fact of common 
observation, that moderately loose clothing is warmer 
than close-iitting. 

Especial attention should be given to the shape 
and fitting of foot-wear. Boots and shoes are usually 



230 TEXT-BOOK OF HYGIENE. 

made with little regard to the physiological anatomy 
of the foot, and as a result the feet of most Americans 
are deformed, beauty and usefulness being in a great 
degree sacrificed to the Moloch of fashion.* 

Dyes used for coloring fabrics are sometimes poi- 
sonous. The author has repeatedly seen troublesome 
eruptions and even ulcerations of the legs from wear- 
ing stockings dyed with aniline compounds. 

By appropriate treatment clothing can be made 
non-inflammable. Tungstate and phosphate of soda 
are used to reduce the inflammability of fabrics. The 
addition of 20 per cent, of tungstate of soda and 3 per 
cent, of phosphate of soda to the starch sizing used for 
stiffening linen is effective. The material is not injured 
by it, and a smooth surface and polish can be obtained 
under the hot iron. Prof. Kedzie has recommended 
borax for the same purpose. He says: 'The simplest 
and easiest way to make your cotton and linen fabrics 
safe from taking fire is to dissolve a heaped teaspoon- 
ful of powdered borax in half a pint of starch solution. 
It does not injure the fabric, imparts no disagreeable 
odor, and interferes in no way with the subsequent 
washing of the goods. Tt does not prevent the forma- 
tion of a smooth and polished surface in the process of 
ironing. Borax can be found in every village, and is 
within the reach of all. It is a cheap salt, and its use 
for this purpose is very simple.'f 

[The following works may also be studied to 
advantage : 

Hammond: ITysiene, p. 579. L. Meyer : Kleidung, in T?ealencyclo- 
psedie d. g^s. Heilk., Bd. VII, p. 446. Van Haklinge^ : Care of the Peison, 
in Bock's Flysriene and Public Heath. TT oi. I] 



t Michigan State Board of Health, 1880, p, : 



CHAPTER XVI. 

DISPOSAL OF THE DEAD. 

When life is extinct in the animal body, decom- 
position begins. This may be either putrefactive or 
non-putrefactive. The difference between the two pro- 
cesses has been explained by Leibig. In putrefaction 
of organic matters, only the elements of water take 
part in the formation of the new compounds which 
result, while in non-putrefactive decomposition or 
decay, the oxygen of the air plays an important part. 
Putrefaction can go on under water, while decay can 
only take place when the supply of free oxygen is 
abundant. 

The prompt removal of the bodies of the dead 
from the immediate vicinity of the living is a matter 
of prime sanitary importance. If death results from 
a contagious or an infectious disease, the necessity for 
the removal of the corpse is evident. But, even where 
there is no danger of propagation of infectious disease, 
the products of putrefaction and decay may give rise 
to serious derangements of health if allowed to pollute 
the air. 

The chief methods of disposal of the dead are 
burial in the earth, entombment in vaults, and ere' 
mation. 

INTERMENT. 

The most common method of sepulture is burial 
in the earth. The corpse is usually enclosed in a case 
(coffin) of wood, or metal, and buried from four to six 
feet deep. Here decomposition sets in, which is at first 
putrefactive, and later on non-putrefactive. In the 
course of several years, from live to ten, the entire 



ZJV TEXT-BOOK OF HYGIENE. 

body with the exception of the bones has usually dis- 
appeared, and becomes converted into a dry monld. 

The soil of a burial ground should be dry and po- 
rous, so as to be easily permeated by the air. In a 
sandy or gravelly soil, the decay of a corpse is much 
more rapid than in a moist, clayey soil. In the latter, 
the bodies more readily undergo putrefaction or 
become converted into a substance termed adipocere. 
It has been calculated that in a gravelly soil the decay 
of a corpse advances as much in one year, as it would 
in sand in one and two-thirds, and in clay in two to 
two and one-third years. The decay of the dead bod- 
ies is principally (if not entirely) dependent upon the 
presence of living vegetable organisms. If the access 
of free oxygen is prevented, the bacteria of putrefac- 
tion will thrive and cause putridity. If, however, the 
soil is loose, porous, and easily permeable by the air, 
the bacteria of decay will be present and produce their 
characteristic effects. 

The barometric pressure seems to affect the decom- 
position of dead bodies. For example, at the refuge 
of St. Bernard in the high Alps, the bodies of those 
dying are not buried, but exposed to the air, where 
they undergo a drying, shrinking and mummification, 
instead of putrefaction or decay. 

Alternate saturation and drying of the soil pro- 
motes the rapidity of decay. 

Certain occupations are said to produce changes in 
the tissues which resist decay. Thus tanners are sup- 
posed to resist the final changes of the tissues longer than 
persons of other occupations. Shakespeare makes tne 
grave-digger in Hamlet say: 'A tanner will last you nine 
years.' The corpses of those poisoned by phosphorus, 
arsenic, sulphuric acid or corrosive sublimate also 
decay more slowly than those of cases of infectious 
diseases. 



DISPOSAL OF THE DEAD. 233 

All the tissues may be converted into adipocere, 
but in the large majority of cases only the fat and 
connective tissue undergo this change. 

SUPPOSED DANGERS OF BURIAL GROUNDS. 

Popular sanitary literature teems with supposed 
instances of the injurious influences of cemeteries upon 
the health of persons living in their vicinity. An 
unprejudiced consideration of the subject shows, how- 
ever, that there is .no trustworthy evidence that any of 
the gases exhaled by decaying or putrefying bodies are 
injurious to health. The air of closed burial vaults 
may be dangerous from the large proportion of carbonic 
acid contained in it, but the other gaseous products of 
decomposition have no deleterious effects. The dan- 
gers to health from the proximity of cemeteries are 
doubtless very much exaggerated. Pettenkofer and 
Erismann have shown that a single large privy vault, 
containing about 600 cubic feet of excrement, gives off 
nearly as large an amount of putrefactive gases in the 
course of one year, as is exhaled by a burial ground 
containing 556 decomposing corpses in ten years. 

Where bodies are properly buried, and the ground 
is not overcharged by corpses, it is not probable that 
infectious diseases are propagated from interred bodies. 
There are no facts on record that show that such an 
event has occurred. 

The dangers of pollution of water by cemeteries 
have also been much overestimated. The purifying 
power of soil strata through which the water is com- 
pelled to percolate before reaching the well, after be- 
coming charged with the products of decomposition, is in 
most cases sufficient to remove all deleterious matters. 

Cemeteries should not be located within a city, but 
must be easily accessible. The soil should be dry 



234 TEXT-BOOK OF HYGIENE. 

gravel or sand, with a low ground- water level. The 
graves need not be deeper than four feet to the top of 
the coffin. 

ENTOMBMENT IN VAULTS. 

Burial vaults in churches, or in the open air should 
be discountenanced. The gases of decomposition are 
given off directly to the air without the modifying 
power of the soil, and often constitute a nuisance, even 
if not deleterious to health. Entombment in vaults or 
crypts has not a single favorable circumstance to 
recommend it. 

CREMATION. 

Within recent years the rapid incineration of the 
dead in properly constructed furnaces has been fre- 
quently recommended. In the United States a crema- 
tion furnace was built several years ago at Washington, 
Pa., by the late Dr. J. C. LeMoine. Among the re- 
mains of those cremated were those of the late Dr. 
Samuel D. Gross, the distinguished surgeon. The prac- 
tice has not gained very many adherents, however, 
although cremation societies have been organised in sev- 
eral of the cities throughout the country. Aside from 
the objections urged by the more conservative classes 
who desire to adhere to the time-honored custom of in- 
terment, serious legal objections have been brought for- 
ward. In cases where poisoning was suspected some 
time after death, the cremation furnace would have 
destroyed every evidence of crime, and conviction of a 
criminal poisoner could not be obtained. 

The real advantages of cremation, such as rapid 
destruction of a corpse, economy of space in keeping 
the remains, and avoidance of pollution of the soil by 
decaying bodies, and possible pollution of air and 
water, are more than counter-balanced by the expense 
and the medico-legal objection mentioned. From a 



DISPOSAL OF THE DEAD. 235 

sanitary point of view, cremation is not necessary in 
this countrj\ A proper regulation of cemeteries will 
prevent any possible dangers to the living from pollu- 
tion of the air, soil or water by the decaying remains 
of human beings. 

INTERMENT ON THE BATTLE FIELD. 

After battles, the disposal of the bodies of the 
slain is often a serious problem. Nsegeli proposes the 
following method of interment: After selecting the 
place of burial, the sod and layer of humus are removed 
from a sufficiently large surface and thrown to one side. 
The corpses are then laid upon the denuded place, and 
the layers of corpses separated by sand, gravel, or line 
brush- wood. A trench is then dug around the pile of 
dead and the soil gained is thrown over the corpses 
until they are covered to the depth of three feet, when 
the humus and sod are placed over the whole. This 
furnishes a dry grave in which decay rapidly takes the 
place of putrefaction, and the corpses soon moulder 
away. The same procedure may be followed in cases 
of epidemics where the number of deaths is too great 
to properly bury them in single graves. 



CHAPTER XVII. 

THE GERM THEORY OF DISEASE. 

The ruling doctrine in the pathology of the present 
day is the germ theory of disease. Based upon the 
doctrine of omae vimim ex vivo, and supported by strong 
experimental and clinical evidence it is accepted by the 
great majority of physicians. Its advocates claim that 
the large class of diseases known as contagious or 
infectious, are all due to the presence in the blood or 
tissues, of minute organisms, either animal or vegeta- 
ble. Many other diseases, not at present included in 
the above class by general pathologists, are also be- 
lieved, by the adherents of the germ theory, to be 
caused in the same way. The following constitutes a 
brief review of the most prominent facts in the history 
of the doctrine : 

The doctrine of the vital nature of the contagium 
of disease — the contagium animatum of the older 
writers — was held in a vague way by many of the phy- 
sicians of the past, but it was not until the latter part 
of the last century that the theory took definite shape. 
In the works of Hufeland, Kircher and Linn6, the idea 
is expressed with more or less directness that the prop- 
agation of infectious diseases depends upon the implan- 
tation of minute independent organisms into or upon 
the affected individual. This hypothesis was, however, 
first clearly enunciated, and defended with great force, 
by Henle, in 1840. Three years earlier, Cagniard de la 
Tour and Schwann, had established a rational basis for 
the theory by their observations upon the yeast plant 
and its relation to fermentation. In 183o, Bassi had 
discovered in the bodies of silkworms affected by mus- 
Caroline, a disease of these insects which proved very 



THE GERM THEORY OP DISEASE. 237 

destructive, a parasite which was soon shown to be the 
cause of the disease. Within the next few years, 
TulasnS, DeBary and Kuehn, proved that certain fungi 
were the causes of the potato rot and other diseases of 
plants. Schcenlein, Malmsten and Gruby, between 1840 
and 1845, demonstrated that those skin diseases of man 
classed as the tinea, were due entirely to the action of 
vegetable parasitic organisms. 

Up to this time the germ theory, as now accepted, 
had received no support from experiment. All the dis- 
eases claimed as parasitic were purely local; so far as 
the parasitic nature of the general diseases was con- 
cerned, all was hypothetical. In 1849, Guerin M6ne- 
ville discovered a corpuscular organism in the blood of 
silkworms affected by the pebrine, which was later 
proven by Pasteur to be the true cause of this destruc- 
tive disease. Pollender, in 1855, and Brauell, in 1857, 
found numerous minute rod-like organisms (bacteria) 
in the blood of animals dead with splenic fever. In 
1863, Davaine, investigated the subject more fully, and 
showed beyond doubt that the little organisms dis- 
covered by Pollender were the true cause of splenic 
fever, or anthrax. The more recent researches of 
Koch upon the history of these bacteria or bacilli of 
splenic fever have removed all doubt of their etio- 
logical significance. 

The careful observations and researches of such 
scientific investigators as Rindfleisch, Waldeyer, Yon 
Recklinghausen, Chauveau, Billroth, Carter, Burdon 
Sanderson, Koch, and others, have established the 
theory upon a secure foundation. There is an increas- 
ing number of diseases for which the parasitic origin 
may be accepted as fully proven. Among these are 
splenic fever, relapsing fever, erysipelas, actinomycosis, 
glanders and diphtheria. For another class of diseases 
including tuberculosis, pleuro-pneumonia of cattle, 



238 TEXT-BOOK OF HYGIENE. 

cholera, typhoid fever and croupous pneumonia, the 
etiological connexion between the organisms, and the 
disease, appears probable. For a very large remaining 
class of diseases, however, there is no trustworthy 
evidence to show their origin from parasitic micro- 
organisms. 

In connexion with the germ theory, there has 
arisen of late a very important question in its bearing 
upon preventive medicine. This is the value of the 
so-called protective inoculations against infectious 
diseases. The protective influence of vaccination 
against small-pox is firmly established by indubitable 
evidence. Within the last three or four years a pro- 
cedure introduced by Pasteur to protect animals against 
certain fatal infectious diseases, such as splenic fever, 
fowl cholera and rabies, has claimed much attention. 
Pasteur's observations were first made upon the disease 
termed chicken cholera. He found that the blood of 
the dead fowls, or of those attacked by the disease 
swarmed with bacteria. Inoculation of healthy fowls 
with this diseased blood, or with the bacteria alone, 
carefully freed from all animal fluids, produced the 
same disease. The bacteria were therefore assumed to 
be the cause of the disease. The investigator then took 
a quantity of these bacteria and 'cultivated' them 
through a number of generations, using sterilised 
chicken broth as a culture medium. Fowls inoculated 
with the result of the last cultivation were still 
attacked by the same symptoms but in a very mild 
degree, and almost uniformly recovered from the 
disease. On subsequent inoculation with infected 
blood, no effect was produced upon the 'vaccinated' 
fowls, while the same blood introduced into fowls not 
'protected' by the previous inoculation, produced its 
customary fatal effect. Pasteur and others repeated 
these experiments with the organisms found in the 



THE GERM THEORY OF DISEASE. 239 

blood in splenic fever and obtained similar results.* 
These protective inoculations have been made upon 
large numbers of sheep and cattle within the past three 
years, and with very remarkable success. Recently, 
however, it has been shown that the protection afforded 
by the inoculation is a very temporary one, and that 
after a variable but brief interval, the protected 
animals are again liable to be fatally attacked by the 
disease. The opinion seems to be justified that culti- 
vation produces only a temporary degeneration of the 
bacteria, which rapidly disappears when the organisms 
are again brought in relation with their proper nutri- 
tive fluid. The 'protective inoculations' produce a 
mild attack of the disease, which is for a time a bar 
against a second attack, but the effect soon wears off, 
leaving the animal in its pristine condition of recep- 
tivity toward the infective material. 

[The following works on this subject are recom- 
mended to the student: 

Sternberg and Magnin : The Bacteria ; second pdition. Fluegge : 
Fermen eund M kropirasiten.m Von PettenkofektjndZiemssen'6 Hand- 
buch d. Hyeiene] 

* As these sheets are passing t hrough the press, Pasteur reports a like success 
with the cultivated 'miciobe ' of rabies. 



CHAPTER XVIII. 

CONTAGION AND INFECTION. 

The adjectives, contagious and infectious, are used 
to designate certain diseases which are propagated by 
immediate contact, or through the intervention of some 
other medium, from the sick to the healthy. Thematters 
in which reside the morbific power, are now believed by 
many to be vegetable organisms, but not a few pathol- 
ogists hold to the view that the real contagia, or dis- 
ease-bearing agents, are modified animal cells or abnor- 
mal fluids. 

The differentiation between contagion and infection 
is not easy. Many of the diseases commonly called 
contagious, are also infectious, that is, they are propa- 
gated not merely by direct contact, but also by air, 
water or food which may have become infected with 
the morbific agents. Syphilis, for example, may be 
regarded as simply a contagious disease ; at the present 
day, at least, we cannot conceive syphilis to be propa- 
gated by breathing infected air, or drinking water con- 
taminated with the poison of syphilis. Cholera, typhoid 
and yellow fevers, on the other hand, are examples of 
infectious diseases, neither of them being directly con- 
tagious, but conveyed from sick to well through the 
medium of contaminated air, water or food. Between 
these two stand small-pox and typhus fever, ( and per- 
haps the other exanthemata) which are not merely con- 
tagious but infectious also. 

There is still a third class of acute diseases, not 
properly included in either of the classes mentioned. 
This is the class of miasmatic diseases, of which mala- 
rial fevers are the type. According to recent observa- 
tions, pneumonia ought perhaps to come in this class. 



CONTAGION AND INFECTION. 241 

The contagious and infectious diseases are of par- 
ticular interest to sanitarians, because it is believed 
that by the judicious carrying-out of sanitary measures 
they can be prevented. Hence they are sometimes 
termed preventable diseases. Another peculiarity of 
the infectious diseases is that they usually occur in 
groups of cases. Thus small-pox, measles, scarlet fever, 
typhus fever, diphtheria, and others of the class do not 
occur sporadically, as it is termed ; that is to say, it 
rarely happens that only one case of small-pox is 
observed in a locality, unless active measures are at once 
taken to stamp it out. Usually a number of cases occur 
successively, and in most instances the succeeding cases 
can be traced ultimately to the first case. 

Contagious and infectious diseases frequently ap- 
pear as epidemics. Authorities differ as to the proper 
definition of an epidemic; that is, given the population 
of a place, how many cases of an infectious or conta- 
gious disease* are necessary before the disease can be 
considered epidemic at such place. The following for- 
mula was given by the New Orleans Medical and Sur- 
gical Association in response to the query : 'Under 
what circumstances is it proper to declare such diseases 
(diphtheria, scarlet fever, measles, small-pox, yellow 
fever, etc.) epidemic in a place?' The answer given is 
that the disease should be declared epidemic when the 
number of cases should reach these proportions :* 

For a population of 100 5 per cent. 

500 - - • 4 " 

" 2,000 to 5,000 - 22£ " thousand 

" 6,000 " 10,000 - 16 

" 20,000 " 50,000 - ♦ 8 " " ten thousand 

" 50,000 " 100,000 4 " " 

" 200,000 1 " " 

A disease is said to be pandemic when it spreads 
rapidly over a great extent of country, and endemic 
when it is . constantly present in a place. Diseases 

* Public Health. Vol. VI, p. 416-417. 



242 TEXT-BOOK OF HYGIENE. 

which may be prevalent in certain localities, i. e., en- 
demic, not infrequently spread over larger areas of 
country, overflow their borders, as it were, and become 
epidemic or pandemic. Thus cholera, which is endemic 
in certain districts of India, frequently spreads over 
adjacent territory, and, at times, the epidemic wave, 
as it has been called, rolls over nearly the whole world. 
Plague, malarial and yellow fevers make similar epi- 
demic excursions into other countries, or sections of 
country, at a distance from the places where they are 
endemic. 



CHAPTEK XIX. 

HISTORY OF EPIDEMIC DISEASES. 

An important part of the knowledge of the sani- 
tarian, is that which relates to the history of the great 
epidemic diseases that have at various periods devas- 
tated large areas of the inhabited world. In this 
chapter the history of these diseases will be briefly 
traced. Although some of these diseases have nearly 
or quite ceased, a knowledge of their habits, and of 
the causes which finally led to their extinction is of 
great value, for the reason that the principles and 
measures of prevention which were effective in times 
past, are the same which must apply at present and in 
the future. Hence, time spent in looking back over 
the fields traversed and noting victories won, will not 
be wasted. 

The epidemic diseases which will here claim atten- 
tion are, the oriental plague, the sweating sickness, 
small-pox, Asiatic cholera, typhus, typhoid, scarlet, 
relapsing, and yellow fevers, diphtheria, dengue, epi- 
demic influenza and syphilis. In addition, some infor- 
mation will be given on certain of the diseases of ani- 
mals transmissible to man. Among these are sheep 
pock, actinomycosis, bovine tuberculosis (perlsucht), 
rabies, anthrax (milzbrand), and glanders. 

THE OKIENTAL PLAGUE. 

The oriental plague, bubonic plague, the black 
death, or simply 'the plague,' or great pestilence, over- 
topping in its fatality all other pestilences, is men- 
tioned by a number of the Greek and Latin medical 
authors. The first account which clearly refers only to 
this disease is given by Procopius. According to this 



244 TEXT-BOOK OP HYGIENE. 

and other contemporary authors, the disease began to 
spread in the year 542 from lower Egypt, passing in 
one direction along the coast of northern Africa, and 
in the other invading Europe by way of Syria and Pal- 
estine. In the course of the succeeding years this pan- 
demic reached 'the limits of the inhabited earth' in 
the language of the writers of the day. The disease 
prevailed about half a century, and produced the 
greatest devastation wherever it appeared. 'Cities 
were devastated, the country converted into a desert, 
and the wild beasts found an asylum in the abandoned 
haunts of man.'* 

The plague is an acute infectious disease, which is 
characterised by an affection of the lymphatic system, 
i. e., inflammation and swelling of the external and 
internal lymphatic glands. Accessory symptoms are 
petechial spots upon the skin, and hemorrhages from 
various organs, as the stomach, nose, kidneys, rectum 
and uterus. Those attacked suffer in varied degrees of 
intensity. In some, a fulminant form occurs which 
carries off the patient within three days; there is 
another class of cases in which buboes develope, with 
accompanying fever and hemorrhages, and finally a 
light form, rarely fatal, in which only the local symp- 
toms are manifested. In the great pandemic of the 
plague in the fourteenth century, cough and bloody 
expectoration were very frequent. In the later epi- 
demics hemorrhage from the lungs has been rarely 
noticed as a symptom. 

About the middle of the fourteenth century the 
bubonic plague made a second incursion into Europe 
from its home in the east. A most graphic description 
of its ravages is given by Boccaccio in the Decameron. 
This author states that 'between March and July follow- 
ing, according to authentic reckonings, upward of a 

* Warnefbid : quoted by Hirsch : Hist-Geographische Pathologie, I., p. 350. 



HISTORY OF EPIDEMIC DISEASES. 245 

hundred thousand souls perished in the city (Florence); 
whereas, before that calamity it was not supposed to 
contain so many inhabitants.' 

This terrible epidemic was forcibly characterised 
by its common name, 'the black death.' Hecker esti- 
mates that during its continuance, from 1347 to 1351, 
25,000,000 — one-fourth of the probable total population 
of Europe — died. In various cities the mortality was : 
in London, 100,000; in Paris, 50,000; in Venice, 100,000; 
in Avignon, 60,000; in Marseilles, 16,000 in one month. 
It was said that in all England, scarcely a tenth part 
of the population escaped death from the disease. 

The moral effects of this great pandemic of the 
plague were hardly less deplorable than the physical. 
Religious fanaticism held full sway throughout Europe, 
finding its vent in all manner of excesses. The so- 
called Brotherhood of the Cross, otherwise known as 
the Order of Flagellants, which had arisen in the 
thirteenth century, but had been suppressed by the 
ecclesiastical authorities, was revived during the black 
pestilence, and large numbers of these religious enthu- 
siasts roamed through the various countries on their 
great pilgrimages. Their power increased to such a 
degree that Church and State were forced to combine 
for their suppression. One consequence of this fanat- 
ical frenzy was the persecution of the Jews. These 
were accused of being the cause of every evil that befel 
mankind, and many were put to death. 

In the fifteenth and sixteenth centuries the plague 
was generally diffused throughout Europe, and in the 
second third of the seventeenth century, its final incur- 
sion into the Occident took place. The great epidemic 
in London, so graphically described by Defoe, * occurred 
in 1665. In the early part of the eighteenth century 
(1720) the plague visited Marseilles and Toulon; from 

* Journal of the Plague in London. 



246 TEXT-BOOK OF HYGIENE. 

1769 to 1772, it was epidemic in Moldavia, Wallachia, 
Poland and southern Russia; near the close of the last, 
and again in the beginning of the present century, in 
Transylvania, Wallachia, southern Russia and Greece. 
Very recently, in 1878 and 1879, the plague threatened 
a new irruption into European territory, being epi- 
demic in the district of Astrachan, on the Caspian sea.* 

Although the bubonic plague has never been ob- 
served in America, and has spared Europe almost en- 
tirely during the present century, it still persists in 
certain countries of Asia and Africa, especially in 
Arabia, Mesopotamia, Persia, and the coast of Tripoli. 

The older authors ascribed the origin of the plague 
to various real or supposed conditions. Comets, con- 
junctions of the planets, 'God's just punishment for 
our sins,' and similar causes were advanced to account 
for the outbreaks. Most of the writers of the post- 
medieval and modern epochs ascribed the disease to 
meteorological conditions. Observing the fact that 
the plague never advanced into the torrid zone, and 
that an epidemic generally ended with the advent of 
hot weather, a high temperature was believed to be 
incompatible with the existence of an epidemic, and 
a cold or temperate climate was considered necessary 
to an outbreak of the disease. The exceptions to the 
rule are so numerous, however, that the theory of the 
climatic or meteorological origin of the plague failed 
of support. The theory which ascribed the origin of 
the epidemics to the influence of certain hot and dry 
winds or a high humidity is also insufficient. Certain 
geological formations have been supposed to furnish 
favorable conditions for the development of the dis- 
ease. Facts show, however, that the disease has pre- 
vailed epidemically and endemically in various parts 

* While these sheets are under press (November, 1884) the journals announce a 
new outbreak of the plague in Asiatic Russia. 



HISTORY OF EPIDEMIC DISEASES. 247 

of the earth, and of the most diverse geological char- 
acter. A certain elevation above sea-level has been 
held to confer immunity, but recent observations in 
India show that this belief is unfounded, even places 
at an elevation of 10,000 feet above sea-level giving no 
security against attack. 

There is, however, one point upon which nearly- 
all writers who mention the fact at all agree. This is 
that had hygienic conditions are always present where 
plague prevails. Nearly all observers who have left 
their impressions on record mention the accumulation 
of filth in the houses and streets, deficient removal of 
excrementitious and other sewage matters, crowding 
and imperfect ventilation of dwellings, as causes favor- 
ing the development and spread of the pestilence. All 
point out the necessity of the removal of these evils 
as the most important prophylactic measure to be 
adopted, and all of them further call attention to the 
fact that those classes of the population most exposed 
to these unfavorable influences suffered most from the 
violence of the epidemic. 

The later reports of the epidemics in Persia, India, 
Mesopotamia and Russia, agree in asserting that noth- 
ing seems to have promoted the epidemic and endemic 
prevalence of the plague so much as the material 
wretchedness of the inhabitants of those countries. 
In a collection of papers on the plague, printed by a 
British Parliamentary Commission in 1879, occur these 
statements: 'The filth is everywhere,' says Mr. Ren- 
nie, one of the reporters, ' in their villages, their houses 
and their persons. Their dwellings are generally low 
and ill-ventilated, except through 'their bad construc- 
tion ; and the advantage of the natives in other parts 
of India, of living in the open air, is lost to the vil- 
lagers of Grhurwal, from the necessity of their crowd- 
ing together for mutual warmth and shelter against 



248 TEXT-BOOK QF HYGIENE. 

the inclemency of the weather.' Dr. Dickson, report- 
ing on the plague in Irak Arabi in 1876, says : ' The 
most palpable and evident of all the causes which pre- 
dispose an individual to an attack of plague during an 
epidemic outbreak is poverty. No other malady shows 
the influence of this factor in so striking a degree ; so 
much so, indeed, that Dr. Cabiadis styles the plague 
miseries morbis. In his experience (1876-'77, in Bag- 
dad) he found that the poor were seldom spared, the 
wealthy hardly ever attacked.'* 

The manner of transmission of the plague is gen- 
erally by prolonged inhalation of an infected atmos- 
phere. Hence, it may be termed an infectious disease, 
although it is not improbable that it may be communi- 
cated by direct contact both of persons and of fomites- 

This indicates the measures of prevention to be 
adopted. They consist in a rigid quarantine of per- 
sons and fomites, prompt and complete isolation of 
infected individuals and localities, and destruction (by 
fire) or thorough disinfection by steam or sulphurous 
acid gas of all materials capable of conveying the virus 
of the disease. 

THE SWEATING SICKNESS. 

This name concisely characterises an epidemic dis- 
ease, which for the first time appeared in the city of 
London and other parts of England in the autumn of 
1485. According to Lord Bacon, f the disease began 
about the twenty-first of September, and lasted until 
near the end of October. It broke out a second time 
in the summer of 1507; a third time in July, 1518, 
spreading in the course of six months throughout 
England. In May, 1529, the disease made its appear- 
ance again in the latter country, spreading thence over 
a great part of the continent of Europe. Another very 

* Hiksch, op. cit., p. 370. 
t History of Henry VII. 



HISTORY OF EPIDEMIC DISEASES. 249 

malignant epidemic broke out in the spring of 1551, 
lasting throughout the summer, and limited in its 
ravages to England. 

With this last outbreak in 1551, this disease 
disappeared entirely in England and has not reappeared 
there up to the present day. In the beginning of the 
eighteenth century, however, a disease very similar in 
its symptoms and course broke out in Picardy and 
other districts of northern France, being confined for 
a number of years to this section of the country. 
Toward the end of the century, it spread to the south 
of France, and since that time has appeared epidemi- 
cally at intervals ; 194 distinct outbreaks being observed 
in the course of 156 years, from 1718 to 1874. The 
disease has frequently appeared in Italy since 1755, and 
in various parts of Germany since 1801. In Belgium it 
has been observed at a few places within the present 
century. 

The disease appeared suddenly; often at night 
time. The patient was attacked with palpitation of 
the heart, dyspnoea, great anxiety and oppression, and 
profuse perspiration. A miliary eruption often 
appeared on the skin. In favorable cases these symp- 
toms diminished in the course of one or two days, the 
urinary secretion, which had been suppressed, was 
restored, and the perspiration became gradually less 
free. Recovery ensued in from one to two weeks. In 
the grave cases there were in the beginning of the 
attack, violent headache, delirium, convulsions, fol- 
lowed by a comatose condition, from which the patients 
rarely recovered. 

This disease is undoubtedly of a miasmatic infec- 
tious nature, as proved by its rapid spread, and 
limitation to certain localities. It appears most fre- 
quently in the spring and summer, and is nearly always 
observed in marshy or damp localities. Its spread is 



250 TEXT-BOOK OF iYGIENE. 

favored by a high temperature and humidity. There is 
no apparent connexion between the outbreaks of the 
sweating sickness and overcrowding or other insanitary 
conditions ; in fact, it is stated by numerous observers, 
both old and recent, that children, the aged, and 
generally the poorer classes were remarkably exempt 
from the disease. 

Since the first appearance of Asiatic cholera in 
France, in 1832, an apparently intimate connexion has 
been observed between the occurrence of that disease 
and outbreaks of sweating sickness. A disease strongly 
resembling the sweating sickness has also been observed 
in India in districts contiguous to places where cholera 
was at the time epidemic* 

SMALL-POX. 

The earliest details concerning small-pox are de- 
rived from certain Chinese records, according to which 
it appears that this disease was known in China upward 
of two thousand years ago. It was also known at a 
very early period in India. It is believed to have been 
introduced into Europe in the second century, by a 
Roman army returning from Asia. It is believed that 
the emperor Marcus Aurelius died of small-pox, which 
prevailed in his army at the time of his death. 

The first distinct references to small-pox in medical 
literature occur in the writings of Galen, in the second 
century. Rhazes, in the ninth century, wrote upon the 
disease, describing it very accurately. 

The almost universal susceptibility to small-pox 
caused wide-spread devastation wherever it appeared, 
previous to the introduction of vaccination. The state- 
ment is made that in England, in the last century, 
about one person in every three, was badly pock- 
marked. The mortality from the disease was exceed- 

* Hdrbat : Madras Quart. Med. Journ. 1840-41. Quoted in Hersch ; 1. c. p. 83. 



HISTORY OF EPIDEMIC DISEASES. 251 

ingly great, being, in the latter half of the eighteenth 
century, about 3,000 per million of inhabitants annually. 

In India the mortality from small-pox has been 
exceedingly great within the last twenty years. From 
1866 to 1869, 140,000 persons died in the Presidencies 
of Bombay and Calcutta, having a population of about 
forty millions. Several years later, from 1873 to 1876, 
700,000 died from this disease. 

China, Japan, Cochin China, the islands of the 
China sea, and Corea are frequently ravaged by small- 
pox. In the latter country nearly all the inhabitants 
are said to bear evidence of an attack of the dis- 
ease. 

The Samoyedes, Ostiaks and other natives of east- 
ern Siberia have frequently suffered from devastating 
epidemics. In Kamtchatka, the disease was introduced 
in 1767, and produced frightful ravages. Many villa- 
ges were completely depopulated. 

In Mexico, small-pox was introduced by the Span- 
iards in 1520. In a short time, it carried off over three 
and a half millions of the natives. In the Marquesas 
islands, one-fourth of the inhabitants have fallen victims 
to the disease since 1863. 

It was first introduced into the Sandwich islands 
in 1853, and carried off eight per cent, of the natives. 

Australia, Tasmania, New Zealand and the Fejee 
archipelago remain exempt to the present day from 
small-pox. It has several times been carried to Austra- 
lia by vessels, but has always been promptly checked 
by the vigilance of the authorities. 

On the western hemisphere small-pox was unknown 
before the arrival of the European conquerors. It has 
been spread by the whites, or imported African slaves, 
to nearly all the Indian tribes of both continents. 
When it attacks large communities unprotected by 
previous out-breaks of the disease, or by inoculation, 



252 TEXT-BOOK OF HYGIENE. 

or vaccination its ravages are frightful. The mortality 
of unmodified small-pox is usually between thirty and 
forty per cent. 

Small-pox is a highly contagious and infectious 
disease. It is produced by actual contact, by inocula- 
tion, and by inhaling an atmosphere charged with the 
poison. In order to cause an out break two factors are 
necessary: first, a number of individuals susceptible to 
the disease; and second, the introduction into the body, 
in some manner, of the virus upon which it depends. 

Small-pox is spread from: 1, persons sick with the 
disease; 2, others, not themselves sick, or susceptible, 
but coming in contact with the poison; 3, fomites, 
(cotton, wool, etc.) and 4, the bodies of persons dead 
with small-pox. It is also probable that the air in the 
immediate vicinity of a person sick with small-pox 
becomes charged with the poison and able to convey 
the disease. It is at present impossible' to fix the dis- 
tance to which this infectiousness of the air extends, 
but it does not ordinarily reach beyond the room in 
which the patient is confined. 

It is a fact of common observation that the darker 
races are more commonly attacked, and the disease is 
likewise more fatal among them. The mortality among 
negroes is much larger than among other races. 

It is a current belief that small-pox is only conta- 
gious after the development of the pustules. This is a 
serious error. It is probably contagious in all stages 
of the disease ; certainly as early as the first appear- 
ance of the eruption, and probably even in the stage of 
preliminary fever. 

One attack of small-pox usually confers immunity 
from the disease for life. This rule has its exceptions 
however, which, if not numerous, are yet not infrequent. 
The author has seen a case in which the patient suf- 
fered from a third attack of the disease. 



HISTORY OF EPIDEMIC DISEASES. 253 

The popular belief, that persons suffering from any- 
other acute or chronic disease are less liable to be 
attacked by small-pox than those at the time in good 
health, is erroneous. On the contrary, the subjects of 
chronic disease, such as consumption or dyspepsia, are 
much more liable to succumb to an attack of small- 
pox, than persons previously in good health. 

It is true, however, that individuals suffering from 
some other acute infectious disease, like scarlet fever, 
measles, typhoid fever, etc., are generally, though not 
absolutely, exempt from an attack of small-pox during 
the time they are sick with such other disease. But if 
they are exposed, after recovery, to the small-pox 
infection, their liability to an attack is as great as in 
those who have not passed through a similar disease. 
A number of cases have been reported by Curschmann,* 
in which infection by small-pox took place on the day 
in which convalescence from typhoid fever was es- 
tablished. 

The author has reported a case,* in which the 
patient passed through an attack of erysipelas, during 
the incubative stage of small-pox. From all the evi- 
dence attainable, the incubative stage was not pro- 
longed by the intercurrent erysipelas. 

Epidemics of small-pox usually begin in the 
autumn or winter, and lessen in violence as warmer 
weather approaches. The spread of the disease is slow 
at first, increasing in rapidity as the foci of infection 
multiply. 

When the poison is imported into a community 
late in the spring, or during the summer, the increase 
in the number of cases is exceedingly gradual until 
colder weather sets in. If it is introduced during the 
winter, the disease spreads much more rapidly, but 

* Ziemsskn's Cyclopedia, Vol. II. 

* Medical News, July 7, 1883. 



254 TEXT-BOOK OF HYGIENE. 

decreases, and sometimes almost disappears during the 
summer. On the return of cold weather, however, the 
epidemic starts out with a new lease of activity and 
presents great difficulties to its restriction. 

Inoculation. — The prevention or restriction of such 
a universal and fatal pestilence as small-pox, is a mat- 
ter of the deepest importance. The first attempt to 
limit its fatality dates from the end of the seventeenth 
century. It became generally known in Europe about 
the year 1700, that the intentional inoculation of vario- 
lous matter into healthy individuals induced an attack 
of the disease which generally ran through its various 
stages with less virulence than when the disease was 
contracted in the usual manner. In 1716 and 1717, two 
papers were published in the Transactions of the Royal 
Society of England giving an account of the process of 
inoculation. The attention of the public was especially 
directed to the matter, however, by the famous letter 
of Lady Mary Wortley Montagu, dated April 1, 1717. 
This letter is as follows:* 'Apropos of distempers, I 
am going to tell you a thing that will make you wish 
yourself here. The small-pox, so fatal and so general 
amongst us, is here entirely harmless, by the invention 
of ingrafting, which is the term they give it. There 
is a set of old women who make it their business to 
perform the operation every autumn, in the month of 
September, when the great heat is abated. People 
send to one another to know if any of their family 
has a mind to have the small-pox; they make parties 
for this purpose, and when they are met — commonly 
fifteen or sixteen together — the old woman comes with 
a nut-shell full of the matter of the best sort of small- 
pox, and asks what veins you please to have opened. 
She immediately rips open that you offer to her with 
a large needle — which gives you no more pain than a 

* The letter is addressed to Mrs. S. C. (Sarah Chiswell). 



HISTORY OF EPIDEMIC DISEASES. 255 

common scratch — and puts into the vein as much mat- 
ter as can lie upon the head of her needle, and after 
that binds up the little wound with a hollow bit of 
shell; and in this manner opens four or five veins. The 
Grecians have commonly the superstition of opening 
one in the middle of the forehead, one in each arm, and 
one on the breast, to make the sign of the cross; but 
this has a very ill effect, all these wounds leaving little 
scars, and is not done by those that are not supersti- 
tious, who choose to have them in the leg, or that part 
of the arm that is concealed. The children or young 
patients play together all the rest of the day, and are 
in perfect health until the eighth. Then the fever 
begins to seize them, and they keep their beds two 
days, very seldom three. They have very rarely above 
twenty or thirty in their faces, which never mark; and 
in eight days' time they are as well as before their ill- 
ness. Where they are wounded, there remain running 
sores during the distemper, which I don't doubt is a 
great relief to it. Every year thousands undergo this 
operation; and the French ambassador says pleasantly, 
they take the small-pox here by way of diversion, as 
they take the waters in other countries. There is no 
example of any one that has died in it, and you may 
believe that I am well satisfied of the safety of the 
experiment since I intend to try it on my dear little son. 
'I am patriot enough to take pains to bring this 
useful invention into fashion in England ; and I should 
not fail to write to some of our doctors very particularly 
about it, if I knew any one of them that I thought had 
virtue enough to destroy such a considerable branch of 
their revenue for the good of mankind. But that dis- 
temper is too beneficial to them, not to expose to all 
their resentment the hardy wight that should undertake 
to put an end to it. Perhaps, if I live to return, I may 
however have courage to war with them.' 



256 TEXT-BOOK OF HYGIENE. 

Soon after the date of this letter, the writer's son 
was inocnlated in Turkey, and fonr years later her 
daughter also, being the first subject inoculated in 
England. The practice soon became popular, but 
several fatal cases among prominent families brought 
it into disrepute, and for about twenty years very few 
inoculatious were made in England. It was revived 
about the middle of the century by the founding of a 
small-pox and inoculation hospital in London. This 
continued in operation until 1822. The records of this 
institution showed that only three in a thousand died 
of the disease thus communicated. The practice has 
now fallen into desuetude, being superseded by vacci- 
nation, and prohibited by law in England. 

Inoculation was introduced into this country in 
1721 by Dr. Zabdiel Boylston, of Boston, who had his 
attention directed to the practice by Cotton Mather, 
the eminent divine.* During 1721 and 1722, 286 per- 
sons were inoculated by Boylston and others in Massa- 
chusetts, and six died. These fatal results rendered 
the practice unpopular, and at one time the inoculat- 
ing hospital in Boston was closed by order of the Leg- 
islature. Toward the end of the century an inoculat- 
ing hospital was again opened in that city. 

Early in the eighteenth century inoculation was 
extensively practiced by Dr. Adam Thomson, of Mary- 
land, who was instrumental in spreading a knowledge 
of the practice throughout the Middle States, f 

In China and India, and perhaps other eastern 
countries, inoculation was practiced at a very early 
period. 

The inoculation of variolous matter, although it 
mitigated to a very great degree the attack of small- 



* Dr. Jno. K. Quinan, (Md. Med. Journ., June 23 and 30, 1883.) believes the claim 
of Dr. Boylston to be the first American inoculator open to question. The evidence 
presented is, however, insufficient to discredit the claim of the Boston physician. 



t See Quinan, 1. c, p. 114. 



HISTORY OF EPIDEMIC DISEASES. 257 

pox following, had one very serious objection, aside 
from the small death-rate which was a direct conse- 
quence of it. This was the fact that inoculation always 
produced small-pox, and thus assisted in propagating 
the disease, for however mild the induced disease might 
be, the inoculated individual was liable to communi- 
cate small-pox to others in its most virulent form. 
Hence, nothing short of universal inoculation, which 
was manifestly impracticable, would succeed in reduc- 
ing the danger from the disease. 

Vaccination. — It had been noticed at various times 
that a pustular disease which sometimes appears on 
the udders of cows, called cow-pox, had not infre- 
quently been transmitted to the hands of dairy-maids 
and others having much to do with cows. In course of 
time it was also noticed that persons who had been 
thus attacked never suffered from small-pox. This 
protective power of cow-pox was known as early as 
1713, and in 1774 Benjamin Jesty, a Gloucestershire 
farmer, performed vaccination for the first time on 
record, inoculating his wife and two sons with cow-pox 
matter as a protection against small-pox. 

It is stated that when it became known that Jesty 
had vaccinated his wife and sons, 'his friends and 
neighbors who had hitherto looked upon him with 
respect, on account of his superior intelligence and 
honorable character, began to regard him as an inhu- 
man brute, who could dare to practice experiments upon 
his family, the sequel of which would be, as they thought, 
their metamorphosis into horned beasts. Consequent- 
ly the worthy farmer was hooted at, reviled and pelted 
whenever he attended the markets in his neighborhood,'* 

In 1791 a school teacher in Holstein also inoculated 
three boys with the matter of cow-pox, but nothing is 
known of the subsequent history of these cases. 

* London Lancet, September 13, 1862. 



VOX TEXT-BOOK OF HYGIENE. 

Although the above facts are clearly established, 
it is to Edward Jenner, a modest country doctor of 
Berkeley, in the county of Gloucester, in England, that 
the merit of demonstrating the protective power of 
cow-pox against small-pox, and of diffusing a knowl- 
edge of this fact, is due. Jenner had his attention 
directed to the asserted protection conferred by cow- 
pox during the period of his apprenticeship. After a 
residence in London as a pupil of John Hunter he 
returned to the country to practice his profession. 
About the year 1776 he began studying the question, 
and gathering evidence of the protection afforded 
against small-pox by the accidental inoculation of 
cow-pox virus. For twenty years he studied the sub- 
ject, patiently awaiting an opportunity to put his 
belief to the test of experiment. On the fourteenth of 
May, 1796, he made his first vaccination on a boy 
named James Phirrps. Six weeks later he inoculated 
this boy with variolous matter, but without success, 
no small-pox resulting. Two years later he published 
his pamphlet, entitled 'An Inquiry into the Causes 
and Effects of the Variola Vaccinae, etc.,' in which he 
detailed his observations and experiments. This pub- 
lication produced a great sensation in the medical 
world, and although much opposition was at first man- 
ifested toward his views, he soon gained many adhe- 
rents. 

Vaccination, as the operation for the inoculation 
of cow-pox virus is termed, was rapidly introduced 
into all civilised countries, and soon demonstrated its 
good effects by greatly restricting the prevalence of 
small-pox. It is generally believed that the first one 
to practice vaccination in this country was Dr. Benja- 
min TVaterhouse, of Boston, in the summer of 1800, but 
Dr. John R. Quinan has recently shown* that vacci- 

* Quinan, 1. c, p. 118, 131. 



HISTORY OF EPIDEMIC DISEASES. 259 

nation was introduced into Maryland by Dr. John 
Crawford and Dr. James Smith, at least as early as the 
date generally assigned for its introduction into 
Massachusetts. 

It was believed by Dr. Jenner, and was afterward 
conclusively shown by a number of distinguished 
experimenters, that vaccinia, as the disease produced 
by cow-pox inoculation was called, was merely a modi- 
fication of small-pox, as it existed in the cow. Small- 
pox virus when inoculated upon the cow, produced 
cow-pox; but the latter reinoculated upon man, 
produced cow-pox (vaccinia), and not small-pox. 
Sheep-pock aud horse-pock or 'grease,' are probably 
merely modifications of the disease produced by inocu- 
lating small- pox into those animals. 

When cow-pox virus is successfully inoculated into 
the human system, that is, when a person is success- 
fully vaccinated, the following local and general 
symptoms are observed : 

In the case of a primary vaccination, i. e., where 
the individual has not been previously vaccinated, or 
attacked by small-pox, the point where the vaccination 
is made, shows no particular change for the first two 
days. If the vaccination is successful, a small, reddish 
papule appears by the third day, which, by the fifth or 
sixth day has become a distinct vesicle of a bluish 
white color, with a raised edge, and a peculiar, central, 
cup-like depression, called the umbilication. By the 
eighth day this vesicle has become plump, round, and 
pearl-colored, the central umbilication being still more 
marked. At this time a red, inflamed circle, called the 
areola, appears, surrounding the vesicle and extending 
usually in a radius of from one-half to two inches 
when fully developed. This inflammatory ring is 
usually pretty firm, and there is more or less general 
fever, and often enlargement and tenderness of the 



2bU TEXT-BOOK OF HYGIENE. 

axillary glands. After the tenth day, the areola begins 
to fade, and the contents of the vesicle dry into a hard, 
brownish crust or scab, which falls off between the 
twentieth and twenty-fourth day, leaving a punctated 
scar, which gradually becomes white. 

When the vaccinia has passed through all of these 
stages, especially if the vesicle filled with pearly lymph, 
and the areola have been well developed, the vaccina- 
tion may be considered a success, and the individual 
protected against small-pox for a number of years, if 
not for life. Recently the doctrine has been strongly 
advocated that vaccination is not absolutely protective 
until a subsequent inoculation of vaccine fails to 'take.' 
According to this view, vaccination should be repeated 
until it fails any longer to exhibit any local reaction. 
When this has been attained the individual may be 
considered absolutely protected for life. Theoretically, 
this view has much in its favor, but there is as yet not 
sufficient evidence to establish it as a law. 

It may be stated as an established fact that vacci- 
nation, although carefully performed and successful, 
does not confer absolute immunity from small-pox for 
life. The protective power seems to wear out after a 
time and the individual then again becomes suscepti- 
ble to small-pox. An attack of small-pox in a 
vaccinated individual is, however, nearly always much 
milder than where there had been no vaccination. 
There is no fact in the entire range of medicine better 
established than this: that small-pox in vaccinated 
persons is a much less dangerous disease than typhoid 
fever, while in unvaccinated cases the mortality ranges 
from thirty to forty per cent. An approximate guide 
to the beneficent influence of vaccination upon the 
mortality from small-pox is furnished by a table in 
Seaton's report on vaccination. Before the introduc- 
tion of vaccination, the mortality from small-pox per 



HISTORY OF EPIDEMIC DISEASES. 261 

million of inhabitants of England was nearly 3,000 per 
year. After the introduction of vaccination, the mor- 
tality was reduced to 310 per million per year. 

The most remarkable and convincing statistical 
evidence on the question is given by Drs. Seaton and 
Buchanan of England. During the small-pox epidemic 
in London in 1863, they examined over 50,000 school 
children, and found among every thousand without 
evidence of vaccination, 360 with scars of small-pox; 
while of every thousand presenting some evidence of 
vaccination, only 1.78 had any such traces of small-pox 
to exhibit."* The reliability of general mortality 
statistics may be called in question — in some cases with 
justice ; but the significance of these figures cannot be 
evaded. 

The upper and outer surface of the arm is usually 
chosen as the point where the virus is inserted, al- 
though any part of the body, which can be protected 
against friction, or other mechanical irritation, may be 
selected. The method varies slightly in the hands of 
different vaccinators. The two methods most frequent- 
ly in use are scarification and erasion. The former 
method has the endorsement of Mr. Seaton, the high 
English authority. The method of erasion — scraping 
off the epidermis until the papillary layer of the skin 
is laid bare — is now most frequently used in this 
country. The best instrument to use is a clean thumb 
lancet ; in default of this, an ordinary sewing needle 
answers well. Where animal vaccine is used, the ivory 
slip, or sharpened quill may also be used with satisfac- 
tion to make the scarification or erasion. Whatever 
instrument is used, it should always be kept perfectly 
clean. 

A point of vital importance is that which relates 
to the proper age at which children should be vaccina- 

* Sbaton : Vaccination, in Reynolds' System of Medicine, Second Edition, Vol. 
I. p. 291. 



262 TEXT-BOOK OF HYGIENE. 

ted. Ordinarily vaccination should be performed with- 
in the first six months of life. In time of danger from 
a threatened, or in the presence of an actual epidemic, 
infants may be vaccinated when only oDe day old. 

In order to secure permanent protection against 
small-pox, revaccination should be performed after a 
certain interval. Some place the period at which this 
second vaccination should be done at five years, while 
others allow a longer interval — seven, eight, or ten 
years. The law of Prussia is that every child that has 
not already had small-pox must be vaccinated within 
the first year of its life, and every pupil in a public or 
private institution is to be revaccinated during the 
year in which his twelfth birthday occurs. 

A revaccination, even if successful, rarely passes 
through all the typical stages of a primary vaccination. 
The vesicle rarely becomes so full and plump, and is 
more frequently flat and irregular in outline. Swell- 
ing of the axillary glands and other complications also 
seem to be more frequent than in cases where the vac- 
cination is done for the first time. 

The question, whether the lymph direct from the 
cow, or humanised lymph is the more efficient, has 
caused much discussion. The objections urged against 
the use of humanised virus are : first, that its protect- 
ive power has become diminished by transmission 
through many generations ; second, that it is liable to 
transmit other diseases, such as syphilis, tuberculosis, 
scrofula, etc., third, that it is frequently difficult to ob- 
tain in sufficient quantities in an emergency, such as 
an actual or threatened epidemic. 

The first objection is disproved by the testimony 
of many of the most distinguished medical men in 
Europe and this country. Humanised vaccine virus, 
when properly inoculated, seems to be as completely 
protective against small-pox, as that taken direct from 



HISTORY OF EPIDEMIC DISEASES. 263 

the animal. Among its advantages are that it 'takes' 
more readily, and runs through its stages of develop- 
ment in a shorter time, and that it will retain its active 
properties for a greater length of time than animal virus. 
The physician can usually control the source whence he 
obtains it. He can watch over the subject that furnishes 
it and reject that which is suspicious. With human- 
ised lymph collected by the physician himself, there 
need be no doubt as to its purity or age ; with animal 
lymph furnished by the cultivators of that article, there 
can be no certainty about either of these important 
points. 

That syphilis has been inoculated with humanised 
vaccine virus can no longer be open to doubt. The re- 
cent experiment of Dr. Cory, of England, has settled 
this question definitely. With care, however, this sad 
accident can easily be avoided, and the fact that syph- 
ilis has been so rarely transmitted by vaccination is 
sufficient evidence that the danger of such infection is 
not very great. 

The most serious objection against the exclusive 
use of humanised lymph, is, that in grave emergencies, 
such as a rapidly spreading epidemic of small-pox, it 
is difficult to obtain a sufficient supply of the lymph. 

Humanised virus is inoculated either in the fresh 
state, i. e., the lymph is taken from the vesicle on the 
seventh day, and inoculated directly into the arms of 
other individuals ; or else, the vesicle is allowed to dry 
into a crust, with which a thin paste is made by moist- 
ening with water at the time of vaccination. The 
readiest way of using the crust is, to crush a small frag- 
ment between two small squares of glass, then moisten- 
ing it with a drop of warm (not hot) water, and smear- 
ing it on the spot where the vaccination is to be made. 
With the lancet a number of cross scarifications are 
then made, and the virus well rubbed in. Only so much 



264 TEXT-BOOK OF HYGIENE. 

of the crust should be moistened as will be used at the 
time. Particular care must be taken not to use saliva 
for moistening the crust. Aside from being unclean, 
there is danger of producing blood-poisoning by inoc- 
ulating certain of the oral secretions. 

Animal virus is obtained by vaccinating a calf or 
heifer with vaccine virus, either derived from a case of 
small-pox, from another case of cow-pox orbyreinoea- 
lating humanised virus into the animal. The vesicles 
are opened on the seventh day, and ivory points or the 
ends of quills coated with the lymph, and dried with a 
gentle heat. 

In vaccinating with animal virus, the quill or ivory 
point is first moistened with a drop of water to soften 
the adhering lymph, the scarification or abrasion of 
the skin is then made with the lancet, and the virus 
rubbed well into the scarified spot. 

In using animal virus the successive stages of de- 
velopment are usually one or two days later than when 
humanised virus is used. In the former case the areola 
is rarely developed before the ninth day. 

Certain complications are likely to occur in the 
course of the vaccinia of which the student should be 
aware. 

When the areola appears there is usually more or 
less fever. Sometimes the constitutional manifesta- 
tions are decidedly marked, fever of a high grade 
being not uncommon. In addition to the glandular 
enlargement and tenderness, an outbreak of roseola 
sometimes comes on about the ninth or tenth day. 
This eruption may be mistaken for scarlet fever, but if 
it is remembered that two infectious diseases rarely 
co-exist in one individual during their full development, 
this error will be avoided. 

Erysipelas involving the entire arm is sometimes 
observed as a complication of vaccination. This, in 



HISTORY OF EPIDEMIC DISEASES. 265 

nearly every case, depends upon some depravement of 
the patient's constitution, innutrition, bad sanitary 
surroundings, or perhaps, more frequently, chronic 
alcoholism. Individuals who are habitually intemper- 
ate in the indulgence of alcoholic liquors, are especially 
unfavorable subjects for vaccination. The results are, 
fortunately, rarefy serious to the patient. 

Another inconvenient complication of vaccination 
is the formation of a deep, ill-looking, sloughing ulcer 
at the vaccinated point. This has been, in the author' s 
experience, a much more frequent concomitant when 
animal virus has been used, than when humanised virus 
was resorted to. It should be borne in mind that a very 
sore arm, especially if followed by the formation of an 
ulcer, or gangrenous sore, may not be protective against 
small-pox. Such a patient should not be considered 
properly vaccinated, and must be revaccinated as soon 
he recovers, or immediately, if there is danger of small- 
pox infection. 

Children with eczematous eruptions, however 
localised upon any portion of the body, should not be 
vaccinated until the eruption is first cured, except in 
times of danger from small-pox. The eczema will be 
almost certainly rendered worse in consequence of 
the general hyperemia accompanying the febrile reac- 
tion, and the physician who performs the vaccination 
will be blamed for causing the skin disease. 

The author has placed on record* two cases of gen- 
eral psoriasis following vaccination, and other cases 
have been since reported. Urticaria and exudative 
erythema has also been repeatedly observed. 

As before stated, syphilis may be communicated 
to the vaccinee by vaccine virus obtained from a 
syphilitic subject, but this accident is infrequent. 
There can be little doubt that some of the cases reported 

♦Journal Cutaneous and Yen. Diseases. Vol. I, No. 1, p. 11. 



266 TEXT-BOOK OF HYGIENE. 

as 'vaccinal syphilis,' are cases of tardy hereditary 
syphilis, lighted up by the general systemic disturb- 
ance following vaccination. 

Next in importance to vaccination in the prophy- 
laxis of small-pox, is prompt isolation of the sick. 
]STo one but the medical and other attendants of the 
sick should be allowed to come in contact with them. 
All attendants and other persons exposed to the infec- 
tion should, of course, be promptly vaccinated, unless 
this has been successfully done within the previous year 
or two. 

Disinfection of all discharges from the patient and 
of the room and its contents after the patient has 
recovered or died, must be practised. The best disin- 
fectants in small-pox are bichloride of mercury, free 
chlorine, and sulphurous acid. 

When it is learned that a person has small-pox, if 
he is not removed to a special hospital, a room should 
be prepared for his occupancy. The carpets should be 
taken up and the floor kept clean. Window curtains 
and unnecessary furniture and drapery should be 
removed from the room. After recovery of the patient 
the bed-clothing must be thoroughly disinfected with 
steam or sulphurous acid, or destroyed by tire. 

ASIATIC CHOLEKA. 

The history of a disease which causes the death 
of three-fourths of a million of human beings in the 
country where it is endemic, within the space of five 
years, and which makes periodical excursions, spread- 
ing over the entire globe with destructive violence, 
must surely command the interest of every intelligent 
person. The fact that one of these periodical advances 
of this disease from its home in the far east is even 
now in progress may lend additional interest to the fol- 
lowing pages. 



HISTORY OF EPIDEMIC DISEASES. 267 

Asiatic cholera is an endemic disease of India, 
where it probably originated centuries ago. Some 
authors claim to have found satisfactory evidence of 
its existence in the writings of the classical authors of 
India and Greece, at a period as early as the second 
century of the Christian era. The evidence is however 
not beyond question. The earliest reliable account of 
cholera as it exists in its home is contained in the work 
of a French author/- He describes a pestilence having 
all the characters now recognised as belonging to 
Asiatic cholera, which prevailed in the neighborhood 
of Pondicherry and the Coromandel coast in 1768 and 
1769, and which carried off 60,000 of those attacked by 
it within a year. Dr. Macpherson gives numerous 
references, which indisputably establish the endemic 
existence of cholera in India anterior to the beginning 
of the present century. 

Being endemically prevalent over a greater or less 
area in India for many years, cholera finally, in 1817, 
crossed the boundaries of that country, and advancing 
in a south-easterly direciion, invaded Ceylon, and the 
Sunda islands in 1818. In a westerly direction the 
disease was carried to the islands of Mauritius and 
Reunion, and finally reached the east African coast in 
1820. During this year it also traveled north-easterly 
devastating the Chinese empire for the two following 
years, reaching Nagasaki in Japan in 1822. 

In 1821, the disease spread from India in a 
westerly direction, extending along the east coast of 
Arabia, to the border of Mesopotamia and Persia. In 
the spring of 1822, it began with renewed violence, 
following the river Tigris to Kurdistan, and extending 
further in a westerly direction, reached the Mediter- 
ranean coast of Syria. In the following year, 1823, it 
extended from Persia into Asiatic Russia, reaching 

* Sonnerat : Voyage aux Indes Orientates, Faris, 1T82. 



208 TEXT-BOOK OF HYGIENE. , 

Astrachan on the European border in September, but 
dying out nearly everywhere beyond the borders of 
India during the ensuing winter. 

In 1826, cholera again advanced from India, reach- 
ing Orenburg in Russia, in 1829, and in the following 
year appeared in St. Petersburg. Extending to the 
north and south it invaded Finland and Poland in the 
same year. From Persia, the disease spread to Egypt 
and Palestine in 1830-31. 

From Russia, the pestilence invaded Germany in 

1831, passing thence in 1832 into France, the British 
isles, Belgium, the Netherlands, Norway and Sweden. 
In the latter year, cholera crossed the Altantic ocean 
for the first time, being carried to Canada by emigrants 
from Ireland ; and spreading thence to the United 
States by way of Detroit. In the same year it was 
imported into New York by emigrants, and rapidly 
spread along the Atlantic coast. During the winter of 

1832, it appeared at New Orleans, and passed thence 
up the Mississippi valley. Extending into the Indian 
country, causing sad havoc among the aborigines, it 
advanced westward until its further progress was 
stayed by the shores of the Pacific Ocean. In 1834, it 
reappeared on the east coast of the United States, but 
did not gain much headway, and in the following year 
New Orleans was again invaded by way of Cuba. It 
was imported into Mexico in 1833. In 1835 it appeared 
for the first time in South America, being restricted 
however to a mild epidemic on the Guiana coast. 

While the pestilence was advancing in the western 
hemisphere, it also spread throughout southern Europe, 
invading in turn Portugal, Spain and Italy. 

Extending in an easterly direction from India, the 
disease reached China and Japan in 1830-31 ; west- 
wardly, Africa was invaded in 1834, and ravaged by 
the epidemic during the following three years. 



HISTORY OF EPIDEMIC DISEASES. 269 

This second extensive outbreak of cholera ended 
in 1837, disappearing at all points beyond the borders 
of India. In 184G, it again advanced beyond its 
natural confines, reaching Europe, by way of Turkey, 
in 1848. In the autumn of this year, it also appeared 
in Great Britain, Belgium, the Netherlands, Sweden, 
and the United States, entering by way of New York 
and New Orleans. In the succeeding two years, 
the entire extent of country east of the Rocky mount- 
ains was invaded. During 1851 and 1852, the disease 
was frequently imported by emigrants, who were 
annually arriving in great numbers from the various 
infected countries of Europe. In 1853 and 1854, the 
disease again prevailed extensively in this country, 
being however, traceable to renewed importation of 
infected material from abroad. In the following two 
years it also broke out in numerous South American 
States, where it prevailed at intervals until 1863. 

Hardly had this third great pandemic come to an 
end, before the disease again advanced from the Ganges, 
spreading throughout India, and extending to China, 
Japan and the East India archipelago during the years 
1863 to 1865. In the latter year it reached Europe by 
way of Malta and Marseilles. It rapidly spread over 
the continent, and in 1866 was imported into this 
country by way of Halifax, New York and New 
Orleans. This epidemic prevailed extensively in the 
western States, but produced only slight ravages on 
the Atlantic coast, being kept in check by sanitary 
measures. In the same year 1866, the disease was also 
carried to South America, and invaded, for the first 
time, the States bordering on the Rio de la Plata, and 
the Pacific coast of the continent. 

While the epidemic was thus advancing westward 
from its home in India, it was at the same time spread- 
ing northwardly over the entire western part of Asia, 



270 TEXT-BOOK OF HYGIENE. 

and in a south-westerly direction over northern Africa. 
In the latter continent it prevailed from 1865 to 1869. 

Cholera never entirely disappeared in Russia 
during the latter half of the sixth decade, and in 1870 
it again broke out with violence, carrying off a quarter 
of a million of the inhabitants before dying out in 
1873. It spread from Russia into Germany and France, 
and was imported in 1873 into this country, entering 
by way of New Orleans, and extending up the Missis- 
sippi valley. None of the Atlantic coast cities 
suffered from the epidemic in 1873, and since that 
year, the United States have been entirely free from 
the disease. 

In 1883, a new epidemic of cholera broke out in 
Egypt, where it raged with great violence. In 1884 it 
was imported into France, extending thence into Italy 
and Spain. The origin and further progress of this 
epidemic, which is still raging at time of writing, (No- 
vember, 1884) cannot yet be written. 

This brief historical sketch of all the epidemics of 
cholera observed beyond the borders of India demon- 
strates several facts: first, that the home or breeding 
place of cholera is in India, whence it spreads at 
intervals throughout the world ; second, that it always 
advances along the lines of travel of large bodies of 
human beings ; third, that it advances, by preference, 
along water routes. The latter is particularly noticea- 
ble in the behavior of cholera epidemics in this 
country. When it has been spread from an Atlantic 
port, it has generally been to other places having water 
communication with that port. It seems to spread with 
difficulty along lines of railroad. When the disease 
has spread from New Orleans, it has always been up 
the Mississippi valley, expending its violence on the 
river cities : Vicksburg, Memphis, St. Louis and Cin- 
cinnati. 



HISTORY OF EPIDEMIC DISEASES. 271 

Several factors must concur before there can be an 
epidemic of cholera. These are, first, the cholera 
poison ; second, certain local conditions of air, soil, or 
water; third, individual predisposition. Without a 
concurrence of all these conditions, no outbreak can 
occur. If by any means the co-existence of these three 
conditions can be prevented, cholera can be prevented. 
The following are facts bearing upon this question : 

Cholera is communicated through the agency of a 
specific poison. This does not admit of doubt. The 
poison may be either organic germ, inorganic particu- 
late, or gaseous. The recent researches of Dr. Robert 
Koch indicate that a micro-organism found in the 
intestinal canal of cholera patients, and termed by him 
the 'comma bacillus,' (really a spirillum, not a bacillus) 
is the active agent in propagating the disease. While 
cholera is not personally contagious in the same sense 
that small-pox is contagious, there can be no doubt 
that it is only spread by the poison from other cases of 
the disease. The regularity of its march along routes 
by which the intercourse of human beings takes place, 
and always in connexion with other cases of cholera 
proves this. There is no undoubted case on record 
where genuine cholera has been spontaneously developed 
outside of India. 

That certain, local geological and perhaps meteor- 
ological conditions are necessary for the propagation or 
virulence of the poison of cholera is beyond dispute. 
In nearly all epidemics, certain cities or towns, or por- 
tions of a town, into which persons sick with cholera 
are brought, and where the poison of the disease is 
thus imported, remain exempt from the effects of the 
epidemic. The inference to be drawn from this fact is 
that in such localities the local conditions are unfavor- 
able to the development of the poison and it becomes 
inert. 



272 TEXT-BOOK OF HYGIENE. 

In India all the local conditions favorable to the 
propagation of the cholera are fonnd. The filthy per- 
sonal habits of the people, the over-crowding, the in- 
tense heat, the lack of sufficient or properly prepared 
food, and the extensive pollution of the water supply, 
all combine to produce the necessary conditions of 
development of the poison. These conditions doubt- 
less, to a considerable extent, give rise to that depres- 
sion of the system which seems necessary to constitute 
the individual predisposition to become infected. 

Given, then, at any place, a number of persons of 
a lowered degree of vitality ; i. e., not capable of 
resisting unfavorable influences under unfavoring con- 
ditions ; given conditions of surroundings more or less 
similar to those present in India, only the introduction 
of the third factor, the cholera poison, is needed to 
cause an outbreak. In many cities of this country, and 
of Europe, as proven by the most recent epidemic in 
Toulon, Marseilles and Naples, the conditions are 
present which would furnish the most favorable nidus 
for the cholera germ if introduced. 

The dejections and vomited matters of cholera 
patients, contain the active agent which produces the 
disease. These excreta are however not infective at 
the time when passed, but must first undergo certain 
changes, before they can reproduce the disease. 

The cholera epidemic in this country in 1873, fur- 
nished a good opportunity for a thorough investigation, 
which was made by order of Congress, under the super- 
vision of the late Surgeon-General Woodworth, of the 
Marine Hospital Service, assisted by Dr. Eli McClellan, 
Surgeon U. S. Army.* The conclusions were put in 
the form of the following propositions, which may be 
regarded as embracing the facts within our knowledge 
at the present time : 

* Cholera Epidemic of 1873. Washington: Government Printing Office. 



HISTORY OF EPIDEMIC DISEASES. 273 

I. That Asiatic cholera is an infectious disease 
resulting from an organic poison, which, gaining en- 
trance into the alimentary canal, acts primarily upon 
and destroys the intestinal epithelium. 

II. That the active agents in the distribution of 
the cholera poison are the dejections of persons suffer- 
ing from the disease in any of its stages. That in 
these dejections there exists an organic matter, which, 
at a certain stage of decomposition, is capable of re- 
producing the disease in the human organism to which 
it has gained access. 

III. That cholera dejections coming in contact with, 
and drying upon any objects, such as articles of cloth- 
ing, bedding, and furniture, will retain indefinitely 
their power of infection. That in this manner a sure 
transmissibility of the cholera infection is effected, and 
that a distinct outbreak of the disease may occur by 
such means at great distances from the seat of original 
infection. 

IV. That the specific poison which produces the 
disease known as cholera, originates alone in India, 
and that by virtue of its transmissibility through the 
persons of infected individuals, or in the meshes of 
infected fabrics, the disease is carried into all quarters 
of the world. That cholera has never yet appeared in 
the western hemisphere until after its route of pesti- 
lential march which had commenced in the eastern 
world, and that its epidemic appearance upon the 
North American continent has invariably been pre- 
ceded by the arrival of vessels infected with cholera- 
sick, or laden with emigrants and their property from 
infected districts. 

V. That the respiratory and digestive organs are 
the avenues through which individual infection is 
accomplished; that through the atmosphere of infected 
localities, cholera is frequently communicated to indi- 



274 TEXT-BOOK OF HYGIENE. 

viduals; that water may become contaminated with 
the specific poison of cholera from the atmosphere, 
from surface washings, from neglected sewers, cess- 
pools, or privies, and that the use of water so infected 
will produce an outbreak of the disease. 

VI. That the virulence of a cholera demonstration, 
the contagion having been introduced into a commu- 
nity, is influenced by the hygienic condition of the 
population, and not by any geological formation upon 
which they may reside.* 

VII. That one attack of cholera imparts to the 
individual no immunity to the disease in the future, 
but that the contrary seems to be established. 

The prophylaxis against cholera comprises such 
measures as prevent the admission of the cholera poi- 
son into a community; prevention of the development 
of the poison after its introduction, and the reduction 
of individual susceptibility to attack. 

It is evident from the foregoing, that if the intro- 
duction of the cholera poison could be prevented, no 
outbreak of the disease could occur. With this in 
view, some have urged the enforcement of a strict pol- 
icy of non-intercourse with infected localities. At the 
present day, few sanitarians advocate these extreme 
measures. A modified system of restricted intercourse 
is supported by many authorities, who claim that by 
the adoption of a thorough system of maritime inspec- 
tion, disinfection, and observation, the poison can be 
rendered ineffective, or its entrance into a community 
prevented. 

The best authorities, however, think that it is not 
only easier, but far more effective, to place the threat- 
ened locality in such a sanitary condition that the de- 

*This proposition by no means controverts the view ot Pettekkofer and his fol- 
lowers, that the movements of the ground-air and ground-water are intimately con- 
nected with the propagation of cholera, as of typhoid fever. The ground-water theory 
has been referred to in Chapter IV., p. 96 , et. seq. 



HISTORY OF EPIDEMIC DISEASES. 275 

velopment of the cholera poison cannot take place. 
The contrast between the effectiveness of quarantine 
and local sanitation as preventives of cholera, has 
been well expressed by Pettenkofer, who compares 
cholera epidemics to powder explosions. The virus of 
cholera, he says, is the spark that evades the strictest 
quarantine. The powder is the ensemble of local con- 
ditions which predispose to the outbreak. 'It is, 
therefore, wiser to seek out and remove the powder, 
than to run after and try to extinguish each individual 
spark before it drops on a mass of powder, *and ignit- 
ing it, causes an explosion which blows us into the air 
with our extinguishers in our hands.' 

The measures of local' sanitation are such as will 
secure cleanliness of person, of habitations and sur- 
roundings, of air, of water, and of soil. Pollution of 
the soil should be especially guarded against, for a 
polluted soil means impure air and water, and these 
mean, if not an infectious disease, at least a heightened 
receptivity to its influence. 

The individual predisposition to cholera is best 
guarded against by keeping the body clean and well- 
nourished. Under-feeding, anxiety, over-work, expo- 
sure to extremes of temperature, intemperance in eat- 
ing and drinking should all be avoided, as they tend to 
reduce the resistance of the system to the influence of 
the morbid poison. 

Certain measures of personal prophylaxis which 
have proven of use heretofore, should be adopted wher- 
ever cholera prevails. One of these is the use of sul- 
phuric acid lemonade. Ten to fifteen drops of dilute 
sulphuric acid in a glass of water, sweetened with sugar, 
may be drunk instead of water. Experience with it 
during the epidemic of 1866, has demonstrated its great 
value as a preventive of cholera. 



276 TEXT-BOOK OF HYGIENE. 

A painless diarrhoea, called cholerine, attacks 
many persons during cholera epidemics. This disorder 
is easily curable if promptly attended to, but if allowed 
to run on, it may develope into a malignant attack of 
cholera. 

Among the means of securing prompt treatment 
of the poorer classes in times of epidemic is the 
establishment of numerous public dispensaries, where 
medical aid can be always obtained. The establish- 
ment of such dispensaries, and, if possible, of tempo- 
rary hospitals in the crowded portions of cities, is a 
very important part of the prophylactic treatment of 
cholera. 

Inasmuch as it seems definitely established that 
the discharges from the stomach and intestines are the 
active agents in propagating the disease, the immedi- 
ate disinfection of such discharges is vitally important. 
The stools and vomited matters must be rendered in- 
nocuous by germicides, such as bichloride of mercury, 
or carbolic acid. Clothing and bedding should be dis- 
infected with superheated steam, sulphurous acid or 
chlorine. Infected articles of this kind should not be 
sent to a laundry until they have been thoroughly dis- 
infected by one of the above mentioned means. 

In the very beginning of an epidemic, prompt iso- 
lation of the sick and thorough disinfection of the sur- 
roundings may check its spread, but much cannot be 
expected from these measures, unless the local sanitary 
conditions are such as to offer a hindrance to the devel- 
opment of the cholera poison. It is plain, therefore, 
that prophylactic measures against cholera, if they 
shall be effective, must be brought into requisition 
before the epidemic has begun. It is of the highest 
importance that preventive measures be enforced in 
time. 



HISTORY OF EPIDEMIC DISEASES. 277 

RELAPSING FEVER. 

Relapsing fever was first clearly described by Dr. 
John Rutty in his 'Chronological History of the 
Weather, Seasons and Diseases of Dublin from 1725 to 
1765.'* Near the end of the last, and in the first half 
of the present centuries relapsing fever was frequently 
met with in an epidemic form in Ireland and Scotland. 
In 1847 the disease invaded a number of the larger 
cities of England. From 1868 to 1873 it prevailed 
extensively in England and Scotland. On the conti- 
nent of Europe it was first observed in Russia in 1833. 
In Germany it was not recognised as a distinct disease 
until 1847, but did not prevail epidemically until 1868. 
Since then it has often been observed in that country. 

Relapsing fever is very prevalent in India, where 
it was first observed in 1856 by Sutherland. In China 
and in the countries of Africa bordering on the Red 
sea, the disease has been recognised by observers. 

In the United States it was first observed among 
emigrants in Philadelphia in 1844, and again in 1869. 
It was conveyed to other places, but has never pre- 
vailed extensively in this country. It has not been 
observed in the United States since 1871. 

The predisposing causes of relapsing fever are 
above all bad sanitary surroundings. Want and over- 
crowding seem to be much less important factors than 
in typhus fever. 

Although relapsing fever has, since it was first 
clearly distinguished from typhus and other continued 
fevers, been recognised as an eminently contagious and 
infectious disease, it was not until 1873 that its imme- 
diate cause became known. In that year Obermeier 
discovered in the blood of patients ill with this disease a 
minute, spiral, mobile organism, now known as the 
spirillum or spirochete Obermeieri. 

* London, 1770. 



278 TEXT-BOOK OF HYGIENE. 

Obermeier and other observers, prominent among 
whom is Dr. Henry V. Carter, have demonstrated the 
constant presence of these organisms in the blood 
during the attack. Carter and Koch have induced the 
disease in monkeys by inoculation of the parasite, and 
Moschutkowski has successfully inoculated it in the 
human subject. No doubt can exist at the present 
day that the spirillum of Obermeier is the true cause 
of relapsing fever. 

The preventive measures consist in attention to 
details of personal hygiene ; in other words, local san- 
itation, disinfection of infected materials, (fomites,) 
and complete isolation of the sick. 

TYPHOID FEVER. 

The first accurate clinical accounts of typhoid fever 
date from the seventeenth century, when Baglivi, 
Willis, Sydenham and others described cases of fever 
which in their clinical characters correspond to the 
disease now known as typhoid fever. Strother, how- 
ever, in 1729, first gave a description of the anatomical 
characters of the disease which he says is 'a sympto- 
matical fever, arising from an inflammation, or an ulcer, 
fixed on some of the bowels.' Bretonneau and Louis 
in France, Hildenbrand in Germany, William Jenner 
in England, and Drs. Gerhard and Pennock in this 
country clearly pointed out the essential distinction 
between typhoid and other fevers, during the first half 
of the present century. 

At the present day, typhoid fever is met with 
everywhere throughout the world. It is at nearly all 
times a constituent of mortality tables. It affects by 
preference persons between the ages of fifteen and thirty 
years, although no age is entirely exempt. It is always 
more prevalent in the autumn and winter. 



HISTORY OF EPIDEMIC DISEASE8. 279 

The disease is probably due to an organic poison, 
which gains entrance into the body through the respi- 
ratory or digestive tract. Recent observations of 
Klebs and Eberth seem to indicate that the morbific 
agent is a micro-organism termed the bacillus 
typlioidens. The exact relation of this organism to 
the disease has not been clearly worked out. It is 
found in the intestinal canal, and especially in the 
characteristic intestinal lesions of this fever. The 
infective agent is probably contained in the dejections 
of patients, but does not become active until after 
undergoing some change outside of the body. The 
disease is not immediately contagious like typhus fever. 

The medium through which the poison is intro- 
duced into the body may be drinking water, food, milk 
or other articles containing the infective agent. Local- 
ised epidemics due to infected water or milk have been 
frequently reported.* 

The typhoid poison is supposed to be developed in 
cess-pools, sewers, and soil polluted by the products of 
animal decomposition. Whether it ever originates de 
novo in such places is a much disputed proposition. 
At present the evidence is in favor of the view that 
cases of typhoid fever are always derived from pre- 
existing cases. The germ may develope in sewers and 
be carried in the sewer air from place to place ; it may 
be carried into the soil from "cess-pools receiving typhoid 
dejections and there undergoing development, may 
ascend through houses with the ground air, or may 
drain into wells and pollute the drinking water. By 
the admixture of such water with milk, or other food, 
the disease may be propagated. It is also believed 
that the effluvia from typhoid discharges may be 
absorbed by water or milk, and thus infect these 
articles. 

* See ante, p. 45-47. 



280 TEXT-BOOK OF HYGIENE. 

The prophylactic measures against typhoid fever 
comprise isolation of the sick, prompt disinfection of 
the discharges, and cleanliness in its widest sense. 
The water and food supplies must be carefully guarded 
against contamination with the poison, and all decom- 
posing animal matter, and excreta must be removed 
from the immediate vicinity of dwellings. The requi- 
sites for prevention may be summed up as pure air, 
pure water, uncontaminated food, and a clean soil. 

TYPHUS FEVER. 

Wide-spread pestilences are nearly always accom- 
paniments of famine and war. Of all pestilential 
diseases, none is so regular in its co-incidence with 
these conditions as typhus fever. The earliest accounts 
which unquestionably refer to this disease date from 
the eleventh century, when it was observed at a number 
of places in Italy. In the succeeding centuries, 
isolated accounts of it appeared in the chronicles of 
the times, but no scientific description of it appeared 
until the sixteenth century. During the seventeenth, 
eighteenth, and the early part of the nineteenth cen- 
turies, it prevailed extensively throughout Europe. 
The constant wars and consequent disturbances of the 
social relations of the people, famines, overcrowding, 
filth, excesses of all kinds contributed largely to the 
development and spread of typhus fever. For a num- 
ber of years past no extensive epidemic of the disease 
has been observed, although both in this country and 
in Europe localised outbreaks are frequently met with. 

Typhus fever is somewhat more prevalent in the 
winter and early spring months than during the rest 
of the year, but not very markedly so. 

At present, typhus fever is nearly always limited 
to times and places where the conditions favoring its 
development exist. Wherever overcrowding, in con- 



HISTORY OF EPIDEMIC DISEASES. 281 

nexion with filth, insufficient food and bad habits are 
present, typhus fever is likely to be a visitor. Thus, 
in overcrowded and ill-ventilated emigrant ships, in 
jails and workhouses, and in camps, especially when 
stress of weather compels the crowding together of 
soldiers in close huts or barracks, the disease frequently 
breaks out. 

When typhus fever appears in a community, those 
classes of the people who are subjected to the condi- 
tions just mentioned are almost exclusively attacked. 
In cities, the dwellers in crowded tenements, or in 
courts and alleys, suffer most severely — are in fact 
almost the only ones attacked. An exception must, 
however, be made in the case of hospital physicians 
and attendants where typhus fever patients are treated. 
The mortality among these is always large. 

Typhus fever is contagious and infectious. An 
exposure for a length of time to an atmosphere impreg- 
nated with the poison may suffice to induce an attack. 
The poison may also be conveyed from place to place in 
fomites. Physicians may carry it in their clothing, if 
they have been exposed to a typhus atmosphere. 

The prevention of typhus fever consists in the 
institution of such measures as will secure pure air, 
pure water, a clean soil and dwellings, and cleanliness 
of body and clothing. When an outbreak occurs, the 
sick should be promptly isolated, the well persons 
removed from the building in which the cases have 
occurred, and efficient measures of disinfection carried 
out. The sick should be treated in the open air as 
much as possible. 

YELLOW FEVEE. 

The West India islands, the Gulf coast of Mexico, 
the northern part of the Atlantic coast of South 
America, and a limited section of the west coast of 



282 TEXT-BOOK OF HYGIENE. 

Africa constitute the present home of yellow fever. 
From this area (the so-called 'yellow-fever zone') the 
disease is frequently transported to contiguous or dis- 
tant countries. The south Atlantic and Gulf coasts 
of the United States, and the shores of the Caribbean 
Sea are most liable to the epidemic visitation of this 
pestilence. 

The first trustworthy account of an epidemic of yel- 
low fever dates from the year 1635, when it prevailed 
on the island of Guadeloupe. This and the adjoining 
islands of Dominica, Martinique and Barbadoes were 
invaded a number of times in the fifty years following 
the above date. Jamaica was invaded in 1655 and 
Domingo the year after. In 1693 the first appearance 
of the disease is mentioned in the United States, being 
observed in Boston, Philadelphia and Charleston. In 
1699 it appeared as an epidemic in Vera Cruz, and re- 
appeared in Philadelphia and Charleston. Since the 
year 1700, the disease has appeared in an epidemic 
form at one or more places within the present limits of 
the United States, seventy-nine times, the last consid- 
erable invasion being at Brownsville, Texas, and Pen- 
sacola, Florida, in 1882. 

In South America, yellow fever appeared for the 
first time in 1740. In 1849, the disease was imported 
into Brazil, and has since theD been endemic. Peru and 
the Argentine Republic have also suffered several severe 
visitations of yellow fever since 1854. 

On the west coast of Africa, yellow fever seems 
to be endemic in the peninsula of Sierra Leone, where 
it has been frequently observed since 1816. It has also 
prevailed epidemically in Senegambia, and a number 
of the islands off the northern portion of the west 
African coast. In Europe, Spain and Portugal have 
been the only countries to suffer from yellow fever 
epidemics. 



HISTORY OF EPIDEMIC DISEASES. 283 

Although the causes of yellow fever cannot be defi- 
nitely stated, it is well-known that it only occurs 
endemically within the tropics, and prevails epidemic- 
ally elsewhere only during the summer. Of 180 epi- 
demics observed in the United States and Bermudas, 
154 began in July, August and September. Of the 
remaining 26, none began in the six months from 
November to April. 

A temperature of 80° F., and a high humidity are 
generally 'considered essential to produce an outbreak 
of the disease. Of other necessary meteorological con- 
ditions nothing is known. 

It seems to be well-established that the most filthy 
and insanitary portions of cities are those principally 
ravaged by yellow fever. The aiithor is convinced from 
personal observation in Savannah, Memphis and New 
Orleans that tilth is one of the principal factors in the 
spread of yellow fever. This opinion is also forcibly 
expressed by many of the most eminent authorities 
upon the subject. 

Yellow fever is not endemic within the limits of 
the United States, and has probably never originated 
here. The instances in which it has appeared to do so 
may be explained by the persistence of the morbific 
agent through one or more winters, or by a new impor- 
tation which has escaped observation. 

Yellow fever frequently breaks out on shipboard 
and causes much loss of life. There is no evidence that 
it originates on ships ; it is only acquired after inter- 
course with an infected ship or an infected place. 

The question of the personal contagion of yellow 
fever has been decided negatively. The disease is in- 
fectious and its cause may be transported in fomites, 
but persons sick with the disease do not communicate 
it. An infected atmosphere, or one favorable to the 
poison, is necessary to the propagation of the disease. 



284 TEXT-BOOK OF HYGIENE. 

The preventive measures indicated against yellow 
fever appear from the foregoing : they are strict sani- 
tary inspection to prevent the introduction of a person 
sick with the disease ; to prevent the introduction of 
clothing or other fomites from a suspected locality 
without thorough disinfection, and such a condition of 
public and private sanitation as will prevent the devel- 
opment of the poison, should the latter, perchance, be 
introduced. 

When the disease becomes epidemic in a city, the 
inhabitants should be removed to temporary camps 
beyond the infected area. The experience of the city 
of Memphis in 1879, encourages the hope that by 
prompt depopulation of <*ties, and strict enforcement 
of sanitary measures in the camps, the terrors of yel- 
low fever can be largely averted. The sick should be 
promptly isolated, and no one except attendants per- 
mitted to have intercourse with them. 

SCARLET FEVER AND MEASLES. 

The early history of these two contagious eruptive 
fevers is' inextricably blended together. Up to the 
latter half of the seventeenth century, the distinction 
between the two was not made by writers. Sydenham 
was among the first who clearly separated scarlet fever 
from measles, and gave it a distinct name. Since the 
great English Hippocrates, the essential character of 
scarlet fever has been recognised by all physicians, and 
it is now never, or but rarely, confounded with measles. 

Of the two diseases, measles is somewhat more 
generally prevalent, although both occur usually in 
epidemics. There is hardly a country in which measles 
has not been observed, while the continents of Asia 
and Africa have remained measurably exempt from 
scarlet fever up to the present time, although epidemics 
have been recorded in India and Japan. 



HISTORY OF EPIDEMIC DISEASES. 285 

Hirsch states that scarlet fever was first observed 
in this country in 1735, at Kingston, Massachusetts, 
quoting as authorities Dr. Douglass, of Boston, and 
Dr. Colden, of New York. The latter, however, in a 
letter to Dr. Fothergill,* clearly describes diphtheria, 
and not scarlet fever. Its distribution is now general, 
but it is said to be much milder in the southern, than in 
other portions of the United States. The prevalence 
of measles is not limited to any geographical section. 

Epidemics of measles usually begin during cold 
weather. Of 530 epidemics observed in Europe and 
North America, 339 occurred during the colder, and 
191 during the warmer months. In 213 of these, the 
height of the epidemic occurred 135 times in winter 
and spring, and only 78 times during summer and 
autumn. Scarlet fever epidemics occur more frequently 
in autumn than at any other season. 

The cause of scarlet fever or of measles is not to 
be sought in climatic influences, insanitary surround- 
ings, or special natural conditions of air, water or soil. 
Both diseases are contagious and infectious, and the 
contagion is transmitted either by fomites, (clothing, 
letters, etc. ) infected air, drinking-water, or milk. 

The measures for the prevention of both diseases 
are isolation and thorough disinfection. 

DIPHTHERIA. 

Under the names of Syriac and Egyptian ulcers, 
Aretseus, a writer of the second century, described 
various forms of malignant sore throat. The disease 
now called diphtheria prevailed at various places in 
Europe during the middle ages. In this country it was 
first observed about the middle of the last century, 
and in 1771, Dr. Samuel Bard, of New York, described 
it very accurately. Although repeated severe outbreaks 

* Medical Observations and Inquiries, London, 1776, Vol. I., p. 211. 



286 TEXT-BOOK OF HYGIENE. 

occurred in Europe in the early part of the present 
century, it was not until 1857 that it again attracted 
attention by its epidemic prevalence in the United 
States. Since that time it has spread throughout the 
country, and is at present one of the most generally 
diffused, as well as one of the most fatal of the con- 
tagious diseases. In certain epidemics its malignancy 
is very marked, while in others it seems to be rather 
a mild affection. 

Diphtheria is personally contagious ; it may be 
transmitted by inoculation, as well as by inhaling an 
infected atmosphere. The virus is supposed by some 
investigators to dwell in a micro-organism, whose viru- 
lence is dependent upon peculiarities of environment.* 

The question as to the identity of diphtheria and 
croup is not merely a clinical one, but has an import- 
ant bearing upon preventive medicine. If croup is a 
non-contagious and non-infectious disease, as is held 
by many, no precautions will be necessary to prevent 
its spread to healthy persons. If, on the other hand, 
diphtheria and croup are identical in nature, the dan- 
ger of infection is equally great in both diseases. In- 
asmuch as it is frequently impossible to positively 
decide upon a diagnosis, it would be well to consider 
the identity of the two diseases as established, and act, 
so far as preventive measures are concerned, as if all 
were cases of diphtheria. 

Diphtheria is inoculable upon animals, and may 
through this medium be transmitted to man. 

Persons sick with diphtheria should be carefully 
isolated ; no one but the immediate attendants should 
be allowed to come in contact with the patients. Table 
utensils, bedding and clothing used by the sick should 
be thoroughly disinfected by steam or boiling water 
before being used by others. Intimate contact with 

* Memoir on Diphtheria, by H. C. Wood and H. F. Formad, Report National 
Board of Health for 1882. 



HISTORY OF EPIDEMIC DISEASES. 287 

the sick, such as kissing, should be strictly prohibited. 
After death or recovery of the patient, the apartment 
occupied during the illness should be disinfected with 
chlorine or sulphurous acid gas. 

Children recovering from diphtheria, scarlet fever, 
measles, or small-pox, should not be permitted to attend 
school for at least four weeks after recovery. It is 
believed that there is danger of infection for a period 
about as long as this, and besides, the patients are apt 
to be weakened from the effects of the disease, and not 
able to resist the strain of continuous mental effort. 



The disease known as break-bone fever, dandy 
fever and by various other names, was first observed in 
the United States in 1780 by Dr. Benjamin Rush. Dr. 
Rush describes an epidemic which prevailed during the 
summer and early autumn of that year, under the name 
of 'bilious remittent fever,' but the symptoms of the 
disease hardly leave any doubt that it was dengue. In 
1779 and 1780 it was also observed on the Coromandel 
coast, in Egypt and on the island of Java. In 1784 to 
1788 dengue also prevailed in various cities of Spain. 
In 1818 an epidemic appeared in Lima, in which nearly 
every one of the 70,000 inhabitants was attacked. 

In 1824-5 the disease again prevailed widely in 
India where it was known as the 'three days fever.' 
Isolated outbreaks occurred in that country until 1853 
when it again appeared as a wide-spread epidemic, and 
in 1872 another epidemic outbreak occurred in the east 
extending from eastern Africa to Arabia, India and 
China. 

In 1826, an epidemic of dengue appeared in Savan- 
nah, and in the following two years spread over the 
southern portion of the United States and the AVest 
Indies, reaching the northern coast of South America. 



288 TEXT-BOOK OF HYGIENE. 

In 1845 to 1849 the disease was observed in Rio Janeiro ; 
in 1848-50 in the south Atlantic and Grulf states. In 
1854 it was observed in southern Alabama, and in the 
same year in the West Indies. In 1873 another 
epidemic appeared in the lower Mississippi valley, and 
in 1880 an outbreak of some extent occurred in New 
Orleans, Charleston and other places on the Grulf and 
south Atlantic coasts. 

Dengue always begins in the summer or early 
autumn, and ceases abruptly with the advent of cold 
weather. It is almost exclusively limited to hot coun- 
tries. It spreads with extreme rapidity wherever it 
appears. It is not contagious; the manner of its prop- 
agation is not known. The susceptibility to the dis- 
ease appears to be almost universal; it frequently pros- 
trates the majority of the inhabitants where an out- 
break occurs. During the epidemic in Calcutta in 
1871-2, seventy-five per cent, of the population were 
attacked. In the United States similar epidemics have 
been repeatedly observed. 

Dengue is rarely fatal. It seems to be propagated 
through the atmosphere. No measures of prevention 
are known or available. 

EPIDEMIC INFLUENZA. 

Accounts of epidemic influenza can be traced back 
to the year 1173, when the disease was observed coinci- 
dently in Italy, Germany and England. It has pre- 
vailed epidemically, at varying intervals, to the present 
time. In the fourteenth century, three epidemics are 
recorded; in the fifteenth, four; in the sixteenth, seven; 
in the seventeenth, forty-six. Of these, fifteen were 
very extensive, some of them prevailing over both 
hemispheres contemporaneously. 

On the American continent, influenza was first 
recorded in 1627, when it prevailed in New England, ' 



HISTORY OF EPIDEMIC DISEASES. ^89 

where it again broke out in 1655. Following this there 
is no notice of the disease in America until 1732, when 
an epidemic began in the New England States, which 
extended over the entire globe. Epidemics occurred 
during the remainder of the eighteenth century in 1737, 
1757, 1761, 1767, 1772, 1781, 1789 and 1798. During 
the present century the disease has prevailed more or 
less extensively in this country at thirteen different 
times, the last epidemic of any considerable extent 
being in 1879. 

A curious feature of epidemics of influenza is the 
coincident occurrence of outbreaks of a somewhat sim- 
ilar affection among animals, horses and dogs being 
especially attacked. 

Influenza is an acute, specific, infectious disease, 
not directly contagious. The infection is apparently 
produced or transmitted in the air. The disease fre- 
quently appears over a large area of country almost 
simultaneously. Peculiarities of climate, season, me- 
teorological conditions, geological formation, or racial 
characteristics, have no apparent influence upon the 
causation or spread of the disease. It occurs more fre- 
quently in the winter and spring than during the sum- 
mer or autumnal months. The investigation into the 
epidemic of influenza among horses, referred to in a 
previous chapter,* seems to indicate, however, that a 
moist and impure atmosphere intensifies the disease. 

No measures of prophylaxis can be indicated, except 
avoidance of anything tending to depress the vital 
powers. 

EPIDEMIC CEREBRO-SPINAL MENINGITIS. 

This disease was first recognised in Geneva in 1805. 
In the following year it was noted in various places in 
the United States. Both in Europe and this country, 

* Chapter I., p. 15. 



290 TEXT-BOOK OF HYGIENE. 

localised outbreaks of the disease occurred between 
the dates above mentioned and 1816. At this time 
the disease seemed to die out altogether, but in 1822 
it reappeared in various parts of Europe and America. 

Cerebro- spinal meningitis appeared in 1857 in the 
south-west of France, and during the following ten years 
spread over a large part of the country. Algiers, Italy, 
Denmark and Ireland were also visited by the scourge. 
In 1854 and 1861, Sweden experienced its ravages, and 
in 1859, Norway was invaded by the disease, which 
continued for nearly a decennium in the latter country. 
From 1860 to 1867 the disease prevailed in Holland, 
Portugal, Germany, Ireland and Russia. 

After the termination of what may be called the 
first epidemic, in 1816, cerebro-spinal meningitis was 
not again observed in this country until 1842. In the 
eight years succeeding, it prevailed epidemically 
throughout almost the whole United States. From 
1861 to 1873, it was noted frequently in various parts 
of the country. Since the latter year the reports of its 
occurrence in this country have been limited to sporadic 
cases or localised outbreaks. 

Cerebro-spinal meningitis is an acute infectious 
disease, very fatal in its tendency. It is probably not 
personally contagious. Climate has no influence upon 
its origin, but season seems to stand in a positive rela- 
tion to its causation. About three-fourths of the epi- 
demics noticed have occurred during the winter and 
spring months. The disease seems to show no prefer- 
ence for peculiarities of topographical or geographical 
formation. Overcrowding, overwork, and uncleanli- 
ness have an important influence in determining an 
outbreak. It is especially a disease of youth and 
adolescence. Out of 975 cases occurring in New York, 
only 150 were over twenty years of age, while of the 
remainder, 665 were under ten. 



HISTORY OF EPIDEMIC DISEASES. 291 

The prophylactic measures to be adopted against 
cerebro- spinal meningitis consist in careful attention to 
the sanitary conditions of dwellings and streets, avoid- 
ance of overwork and overcrowding during times of 
epidemic, isolation of the sick, and disinfection of the 
sick-room after the termination of the disease. 



In the year 1494 Charles VIII, of France, in com- 
mand of a large army invaded Italy, and early in the 
following year besieged Naples. During the investment 
of the city, a very severe disease, characterised by 
ulcers of the genitals, violent pains in the head and 
limbs, and generalised cutaneous eruptions broke out 
among the besiegers and spread rapidly throughout the 
army and the civil population. On the return of the 
army to France after the termination of the war, the 
disease rapidly spread throughout Europe, and the 
literature of the early part of the sixteenth century, 
both medical and lay, teems with references to it. 

From the locality and other circumstances con- 
nected with its epidemic appearance, the disease 
acquired various names. Thus the French called it 
'morbus Neapolitanus,' or 'mal d'ltalie,' while the 
Italians termed it 'morbus gallicus,' or 'mala franzos.' 
At a very early period it was, however, clearly recog- 
nised that the disease was communicated during sexual 
intercourse, and hence it was usually described in 
medical writings under the name 'lues venerea,' while 
in the popular literature it still figured as the French- 
man's disease (morbus gallicus). The name syphilis 
was first used in a poem descriptive of the disease 
written in 1521 by Fracastor, a physician of Verona. 

The extraordinary outbreak of the disease toward 
the end of the fifteenth century, led to many specula- 
tions concerning its origin. As it attacked persons in 



292 TEXT-BOOK OF HYGIENE. 

all .ranks and conditions of life, 'sparing neither crown 
nor cross,' in the words of a contemporary poet, the 
favorite explanation was that meteorological influences 
had much to do with its causation. Many ascribed it to 
the malign influence of the stars. The Neapolitans 
attributed it to the wickedness of their enemies, the 
French, while the latter laid the blame on the filth and 
immorality of the Italians. The Spaniards claimed 
that it had been imported from America by Columbus, 
whose first expedition returned to Europe in 1493. 
There are records, however, which prove that the disease 
already existed in Italy in the latter year. In other 
parts of Europe the Jews, who had been driven out of 
Spain by the terrors of the inquisition, were accused of 
this, as of many other misfortunes which befell the 
people. •, When it was definitely established that the 
disease was communicated almost solely by sexual 
intercourse, the theory of its transatlantic origin 
became very popular. It is a characteristic of human 
nature to refer the origin of troubles resulting from 
its own vices to some other source, if possible. This 
theory of the American origin of syphilis is still held 
by some writers. Within a few years Dr. Joseph Jones, 
of New Orleans, claims to have found evidences of 
syphilitic disease in the skulls and other bones from 
some of the pre-historic Indian mounds in Mississippi. 
These observations of Dr. Jones have however, not yet 
been verified by others. 

Although the first great epidemic of syphilis is 
clearly traceable to the period between the years 1493 
and 1496, an examination of the older literature reveals 
many descriptions of disease which can only be ex- 
plained by assuming them to refer to syphilis. The 
Old Testament Scriptures contain numerous references 
to diseases of the genital organs. In most instances 
these troubles are ascribed to the wrath of God. although 



HISTORY OF EPIDEMIC DISEASES. 293 

in some cases a pretty shrewd hint is given as to the 
causation of the affections. Finaly* remarks that the 
Hebrew word translated in all versions of the Bible by 
'flesh,' signifies also the virile member. In this light 
the references in Leviticus XIII. -XV. ; Numbers XXV. 
1-9; XXXI. 16-18; Deuteronomy IV. 3 ; Joshua XXII. 
17; I. Samuel V. 6, 9, 12; Ps. CVI. 28-30; I. Corinthi- 
ans X. 8; EphesiansII. 11, and Colossians II. 13, receive 
a new interpretation. Numerous innuendoes in the 
Latin classics, and more or less exact descriptions in 
the medical writings of Greece, Rome, China and 
India, leave no room for doubt that venereal diseases, 
and probably among them syphilis, have existed from 
the earliest times. 

At the present day syphilis is the most widely 
prevalent of all contagious diseases. In 1873 Dr. F. 
R. Sturgis estimated that in New York one person out 
of every eighteen suffered from it. This is considered 
a moderate estimate. Dr. J. Wm. White, of Philadel- 
phia, pronounces the opinion that 'not less than fifty 
thousand people of all classes in that city are affected 
with syphilis.' On this basis, Gihon estimates the 
number of syphilitics in the United States at one time, 
at two millions. + 

The disease is transmitted, in the vast majority of 
cases, during the performance of the sexual act, but there 
are numerous other ways in which it may be and fre- 
quently is communicated. In the special literature of 
the subject are records of many cases in which the dis- 
ease was acquired through a kiss, a bite, the act oi 
suckling (from infant to nurse and conversely), using a 
pipe, a glass-blowers' mouth-piece, the finger of a mid- 
wife, the instruments of the dentist or surgeon, inocu- 
lation of syphilitic secretion mixed with saliva in the 

* Arch. f. Dermat. u. Syphilis, II. Jahrg. 1 Heft. p. 136. 

t The Prevention of Venereal Diseases by Legislation. Sanitarian, June, 1882. 



294 TEXT-BOOK OF HYGIENE. 

process of tattooing and many other ways. Numer- 
ous cases have been reported where physicians were 
inoculated on the finger, while examining a syphilitic 
patient. 

The prophylactic measures which suggest them- 
selves from a consideration of the nature of the dis- 
ease, are isolation of those infected, regular inspection 
of the class of persons through whom the disease is 
most frequently transmitted, i. e., prostitutes, and in- 
dividual precautions against acquiring it. Greater 
attention to cleanliness of the genital organs on the 
part of those indulging in promiscuous intercourse, 
would aid largely in reducing the number of cases of 
syphilis. 

DISEASES OF ANIMALS COMMUNICABLE TO MAN. 

SJieeppocJc. — This a highly contagious and infec- 
tious disease of sheep, resembling in its symptoms, 
course and fatality, small-pox as it occurs in the human 
race. It is believed by Bollinger to be different from 
the form of small-pox produced in sheep, goats, horses, 
and other animals by the inoculation of human small- 
pox. Sheep-pock can be inoculated upon other animals 
and man but only produces a local disease at the point 
of inoculation, in the latter. Sheep may be protected 
against this disease by inoculation with sheep-pock 
virus (ovination), or by vaccination with vaccine lymph. 
The peculiarity of sheep vaccinia is that it is a more or 
less generalised disease, the pustules being distributed 
over the body. Sheep-pock when inoculated upon 
human beings does not produce a generalised infectious 
disease, but remains entirely local. 

Actinomycosis. — Veterinarians have frequently ob- 
served a disease attacking the jaws of cattle and pro- 
ducing tumors, often with ulcerated surfaces. The 
bone is usually involved. The disease has heretofore 



HISTORY OF EPIDEMIC DISEASES. 295 

been generally considered a sarcomatous growth. It is 
not seldom observed among the cattle in the western 
stockyards, where it is known in the vernacular as 
'swell-head.' Recent investigations by Ponfick have 
shown that the growth consists of a vegetable parasite 
(actinomyces), and that it is inoculable upon other 
animals, and may be conveyed to man. A considerable 
number of cases have been observed in human beings 
in Germany, where the disease was first described by 
Ponfick, and very recently two cases have been reported 
in this country.* 

Bovine Tuberculosis. — (Perlsucht). In cattle, tu- 
berculosis occurs in two forms, miliary tubercles and 
cheesy masses in the lungs, and firm, pearly nodules 
on the serous membranes. These nodules do not break 
down, but may become calcified. 

Bovine tuberculosis is a frequent disease among 
cows kept in damp, dark and ill-ventilated stables. 
The disease, which is essentially the same as human 
tuberculosis, tubercle bacilli being present in the neo- 
plasms, is believed by many to be transmissible to 
human beings by means of the milk or flesh of tuber- 
culous animals. The sale of meat of tuberculous cattle 
should be prohibited. 

Babies. — Hydrophobia in the brute, and its commu- 
nicability to man through a bite has been known from 
the remotest antiquity. It occurs in dogs, foxes, 
wolves, horses and other animals, and may be trans- 
mitted from any of them to human beings. 

The contagium of rabies, the infective poison, is 
contained principally in the saliva, and is usually inoc- 
ulated by the teeth of the mad animal. 

Pasteur seems to have demonstrated that the virus 
of rabies consists in a micro-organism found in the 
saliva of the rabid animal. By cultivation in appro- 

* Boston Med. and Surg. Journal, Oct. 16, 1884. p. 377. 



296 TEXT-BOOK OF HYGIENE. 

priate culture media, the infectiveness of this organism 
can be modified. When inoculated, after cultivation 
according to Pasteur's methods, it protects the animal 
against the effects of rabies virus.* 

Antlirax. — Anthrax or splenic fever (milzbrand) is 
an acute, highly contagious and infectious disease of 
herbivorous animals which may be transmitted, by 
inoculation or the ingestion of the virus, to other ani- 
mals and to man. 

The disease is due to a minute vegetable organism 
which is found in the blood and tissues of the diseased 
animals. This organism, bacillus anthracis, was first 
discovered by Pollender, and has been thoroughly in- 
vestigated by Davaine, Pasteur, Koch and others. 

Inoculation of these bacilli or their spores always 
produces the disease in susceptible animals. Skins of 
animals not infrequently contain the virus which may 
then gain access to the blood of persons engaged in 
handling them. Knackers, butchers, wool-sorters, and 
other persons liable to come in contact with sick ani- 
mals, or handling their flesh or hides, are subject to 
the infection, either by direct inoculation (through 
abrasions of the skin, etc.,) or by inhalation of the 
spores of the bacillus. An intestinal form of anthrax 
in man, mycosis i/ttesti/talis. is sometimes produced 
by the consumption of meat of animals suffering, when 
killed, of splenic fever. Numerous instances have 
been reported. The diagnosis has been verified by 
discovering the bacillus of anthrax in the blood and 
various organs of the individuals attacked. 

In view of the dangerous character of the disease, 
persons coming in contact with animals suffering from 
anthrax should be warned of their peril. In order to" 
protect other animals in a herd, strict isolation of the 

"Transactions International Medical Congress of 1884. Med. Record, Aug. 30 
1884, p. 247. 



HISTORY OF EPIDEMIC DISEASES. 297 

infected, thorough disinfection of the stables occupied 
by them, and deep interment of the cadavers of those 
dead from the disease are indicated. 

Glanders. — Glanders or farcy is a very fatal con- 
tagious disease of horses which may be communicated 
to other animals and to man. The cause of glanders 
has recently been discovered to be a bacillus resembling 
the bacillus tuberculosis. Pure cultures of this bacil- 
lus were inoculated into animals, and followed by 
glanders in a number of the cases. 

The infection in man may occur either upon the 
seat of excoriations of the skin or mucous membranes, 
especially those of the nose, conjunctiva, and possibly 
by inhalation of infective particles floating in the air. 

Animals with glanders should be promptly killed, 
and their cadavers cremated or deeply buried. No 
part of the body of any animal dead with glanders 
should be allowed to be used. Infected stables should 
be thoroughly disinfected. 

[The works of especial value to students who desire 
fuller information upon the subjects treated in this 
chapter are the following : 

Hirsch : Handbuch der Ristorisch-Geographischen Pathologie, 2te 
Aufi., Stuttgart, 1883. Hecker: The Black Death. Transl. by B. G. Bab- 
ington. Defoe : Journal of the Plague in London; Rohlfs : Die Orienta- 
lische Pest. Marson : Small-pox, in Reynolds' System of Medicine, Vol. I. 
Seaton ; Vaccination, ibid. Trousseau : Clinical Medicine, Vol. I. Fifth 
Annual Report Illinois State Board of Health. Woodworth and McClel- 
lan: Cholera Epidemic in the IT. S. in 1873. Chaille: Report of Yellow Fever 
Commission, in Annual Rep't Nat'l Board of Health for 1880. Wood and 
Formad : Memoir on the Nature- of Diphtheria ; ibid, 1882. Thompson : 
Annals of Influenza. Stille : Epidemic Meningitis. Mueller : Die Ven- 
erischen Krankheiten im Altherthum. Lancereaux : Traite de la Syphilis. 
Bollinger : Ueber Menschen u. Thierpocken, etc. Samml. Klin. Vortr. 
No. 116. Ponfick : Die Actinomycose des Menschen. Gamgee : Hydro- 
phobia and Glanders in, Reynolds' System of Medicine, Vol. I. Bollinger: 
Anthrax, in Ziemssen's Cyclopaedia, Vol. III.] 



CHAPTER XX. 

ANTISEPTICS AND DISINFECTANTS. 

Much, confusion exists in the popular mind and 
even among physicians, as to the exact meaning of 
these two terms. By many they are used synony- 
mously, and hence frequently give rise to ambiguity 
and misunderstanding. 

Antiseptics may be defined as substances which 
retard or prevent fermentation, decay or putrefaction. 
They interfere with the development of the organisms 
which are the causes of these processes. They may 
also retard the development of the organisms which 
cause infectious diseases. On the other hand, the 
action of disinfectants is destructive ; they destroy the 
causes of these diseases. If all infectious diseases are 
assumed to be due to micro-organisms or germs, disin- 
fectants may be considered as equivalent to germicides. 
The difference of action of antiseptics and disinfectants 
can be best understood by assuming that it is merely a 
difference of degree, not of kind. Disinfectants are 
generally antiseptics also, but antiseptics are not in all 
cases disinfectants. 

COMPARISON OF ANTISEPTICS AND DISINFECTANTS. 

This can best be illustrated by quoting some ex- 
periments bearing upon this point. In a recent paper,* 
Dr. Gr. M. Sternberg gives the following table, showing 
the relative disinfectant (destructive of vitality) and 
antiseptic (preventive of development) power, the 
micrococcus of pus being the organism experimented 
with : 

* American Journ. Med. Sciences, April, 18S3, p. &35. 



ANTISEPTICS AND DISINFECTANTS. 299 



Percentage used to Percentage capable 

Agent used. destroy vitality. preventing development. 

Bichloride of Mercury - - 0.005 0.003 

Iodine 0.2 0.025 

Sulphuric Acid - - - 0.25 0.12 

Carbolic Acid ... 0.8 0.2 

Salicylic Acid and Biborate of Sodium 4 0.5 

Alcohol 40 10 

Sulphate of Iron - - Failed in saturated solution 0.5 

Boracic Acid •- " 0.5 

Biborate of Sodium - - " 0.5 

It is readily seen, that while all of the substances 
mentioned acted efficiently as antiseptics in reasonably 
dilute solutions, only two-thirds were efficient disin- 
fectants or germicides. In order to destroy the vital- 
ity of the micrococcus, the solutions were required to 
be from four to eight times stronger than was neces- 
sary to merely arrest its development. In another 
table the same author gives the results of a larger list 
of substances, showing the relative germicidal power 
of the agents experimented with. The table is as fol- 
lows : 

TABLE II.. 

Efficient in the propor- 
tion of one part in 

Bichloride of mercury (0.005 p. ct.) - - - 20,000 

PertnaDganate of potassium (0.12 p. ct.) - - - 833 

Iodine (0.2 p. ct.) - 500 

Creasote (0.5 p. ct.) ...... 200 

Sulphuric acid (0.5 p. ct.) .... 200 

Carbolic acid (1 p ct.) - - - - 100 

Hydrochloric acid (1 p. ct.) - ... 100 

Chloride of zinc (2 p. ct) .... 50 

Tinct. chloride of iron (4 p. ct.) .... 25 

Salicylic acid dissolved by borate of soda (4 p. ct.) - 25 

Caustic potash (10 p. ct.) - ... 10 

Citric acid (12 p. ct.) ..... 8 

Hydrate of chloral (20 p. ct.) .... 5 

Assuming that infectious diseases are caused by 
micro-organisms, and that these are different from the 
micro-organisms of ordinary decay or putrefaction, it 
can be readily understood that the processes of organic 
decomposition may themselves act as disinfectants. It 
is known, for example, that when a fermenting liquid 
putrefies, the organisms of fermentation disappear and 



300 TEXT-BOOK OF HYGIENE. 

give place to the organisms of putrefaction (bacterium 
termo, etc.) So likewise the bacilli of anthrax and of 
tuberculosis are killed by the putrefactive process, if 
this takes place in the absence of free oxygen. Fur- 
thermore, the reproduction of organisms of a certain 
kind ceases when certain chemical (?) changes take 
place in their environment. Fermentation in a saccha- 
rine liquid ceases and the ferment-organisms die when 
the accumulation of the product of the fermentation 
(alcohol) has reached a certain proportion, although 
there may still be undecomposed sugar present. In 
like manner it is intelligible that the products of micro- 
organisms may eventually destroy their producers, and 
so place a limit to the morbid process. The specific 
cause of small-pox, yellow fever, cholera, and similar 
infectious diseases is rapidly destroyed when decom- 
position of the corpses of those dead with such diseases 
sets in. Hence, the reason why infectious diseases are 
not spread from cemeteries. 

These facts also emphasise the necessity of making 
any attempted disinfection thorough ; in other words, 
the disinfectant used should be capable of absolutely 
destroying all disease germs. The addition of an anti- 
septic to material containing disease germs may merely 
preserve the latter by retarding their development. 
By referring to table I., it will be seen that sulphate of 
iron, which is so frequently used to disinfect typhoid 
discharges, sinks and cess-pools, is not a germicide at 
all, while carbolic acid can only be depended upon if 
used in the strength of one part in one hundred. 

From the foregoing it may be gathered that disin- 
fection consists chiefly in a straggle against organised 
disease germs.* As, however, experiments and obser- 
vations have shown that the life-history of disease- 
germs varies with the different organisms involved, it 

* Mueller und Falk, in Realencyelop.vdie d. ges. Heilk. Bd. IV., p. 62. 



ANTISEPTICS AND DISINFECTANTS. 301 

becomes evident that specific directions concerning dis- 
infection can be given only when the life-history of the 
specific organism is known. A valuable contribution 
to this knowledge has been made by Sternberg,* who 
experimented with micrococcus of pus, of septicemia 
of rabbits, bacterium termo, and the bacteria of broken- 
down beef-tea. These experiments showed that as a 
germicide to all these organisms the bichloride of mer- 
cury stands first in the list. In the proportion of 
1 : 20,000 it destroyed the two forms of micrococci 
mentioned, while the bacteria required twice this 
strength, or 1 : 10,000. Iodine was effective in a 1 : 500 
solution on all the organisms, while carbolic acid was 
effective only on the first three when the strength of 
the solution was 1 : 200, or 1 : 100. The .bacteria of 
broken-down beef-tea failed, except in one instance, to 
yield their vitality to a four per cent, solution. 

According to Koch, the following solutions destroy 
the spores of anthrax bacilli within twenty-four hours : 

Chlorine water. 

Bromine, 1 : 50. 

Iodine water. 

Osmic acid, 1 : 100. 

Permanganate of potassium, 1 : 20. 

Bichloride of mercury, 1 : 20,000, in ten minutes. 

These results agree, in general, with those obtained 
by Sternberg and other observers, and it may be ac- 
cepted that corrosive sublimate, iodine, bromine, chlo- 
rine and permanganate of potassium in solution in 
the proportions given are trustworthy disinfectants or 
germicides. As antiseptics they are efficient in much 
more dilute solutions, as shown in table I. 

Liquid disinfectants may be used to destroy the 
infectiveness of excremental materials, to wash infec- 
ted clothing, furniture, rooms or vessels, and for dress- 
ing wounds or ulcers and rendering them aseptic. 



302 TEXT-BOOK OF HYGIENE. 

The principal gaseous disinfectants are sulphurous 
acid, chlorine and nitrous acid. The most gener- 
ally used is sulphurous acid. Dr. Sternberg has 
shown"* that exposure to an atmosphere containing one 
per cent, of sulphurous acid gas for at least six hours 
will destroy the infectiveness of vaccine virus. The 
same results were obtained with chlorine and nitrous 
acid. Sulphurous acid is, however, more readily ap- 
plied than the others mentioned. For an ordinary- 
sized room, one pound of roll sulphur burned in the 
air of the room and confined in it by closing doors and 
windoAvs, should prove an efficient disinfectant. For 
greater safety, twice this quantity should be used. The 
room should remain closed for ten or twelve hours, and 
then all windows opened and the air allowed free access. 
Every room should be thus disinfected after it has been 
occupied by a case of scarlet fever, measles, small-pox, 
typhoid, typhus or yellow fever, diphtheria, cholera or 
similar diseases. Gaseous disinfectants act with greater 
power when the air is moist than when it is dry. It 
would, therefore, be good practice to render the air of 
any room to be disinfected, moist, by means of steam or 
a spray apparatus before using the gaseous disinfectant. 
The spray itself might be rendered disinfectant by 
using a solution of bichloride of mercury, carbolic acid, 
or chlorine water. 

Dry or moist heat (hot air or steam) are the best 
disinfectants where they can be applied. A tempera- 
ture of from 150° to 300° Fahr., is probably sufficient 
to destroy the organic cause of any disease. Steam is 
more efficient than dry heat. While the above temper- 
atures will generally destroy disease-germs, it has been 
shown by Tyndallf that the desiccated spores of the 
common hay bacillus (bacillus subtilis) may withstand 

* Eeport National Board of Health for 1880, p. 318-388. 
t Essays on the Floating Hatter of the Air. 



ANTISEPTICS AND DISINFECTANTS. 



303 



a higher temperature. When steam or hot air (temp . 
230°-250° F.) are used as disinfectants they should be 
under a pressure of one-fourth to one-half atmosphere, 
in order that the material to be disinfected may be 
entirely permeated by the heat. When steam is em- 
ployed, the steaming should continue at least an hour. 
Dry heat should be continued from one to three hours. 
The following substances are antiseptics, but in the 
strength given cannot be depended upon as disinfectants: 



TABLE III. 






Thymol, 


. 


1 : 80,000. 


Bichloride of mercury, 




1 : 40,000. 


Oil of mustard, 




1 : 33,000. 


Acetate of alumina, 




1 : 6,310. 


Bromine, ... 




1 : 5,597. 


Picric acid, 




1 : 5,000. 


Iodine, 




1 : 4,000. 


Sulphuric acid, 


1 


800-1 : 3,353. 


Permanganate of potassium, 


- 


1 : 3,000. 


Camphor, 




1 : 2,500. 


Eucalyptol, - 


- 


1 : 2,500. 


Chromic acid, 




1 : 2,200. 


Chloride of aluminum, 


- 


1 : 2,000. 


Hydrochloric acid, 


- 


1 : 1,700. 


Benzoic acid, 


- 


1 : 1,439. 


Quinine, 


- 


1 : 1,000. 


Boric acid, 


1 


200-1 : 800. 


Salicylic acid, 


1 


200-1 : 800. 


Carbolic acid, 


- 


1 : 500. 


Sulphate of copper, 


. 


1 : 400. 


Nitric acid, 


- 


1 : 400. 


Biborate of soda, 


- 


1 : 200. 


Sulphate of iron, 




1 : 200. 


Creasote, 


- 


1 : 200. 


Arsenious acid, 


- 


1 : 100. 


PyTogallic acid, 


- 


1 :62. 


Tr. chloride of iron, 


. 


1:25. 


Alcohol, - - 40 to 95 per cent. 



[The following additional works are recommended 
for study in connexion with this chapter : 

Sternberg and Magnan : The Bacteria, Second Edition. Fluegge : 
Permente und Mikroparasiten, in Von Pettenkoper tjnd Ziemssen's 
Handb. d. Hygiene. 1 Th., 2 Abth., 1 Hft. Wernich : Desinfectionslehre 
zum praktischen Gebrauch.] 



CHAPTER XXI. 

QUARANTINE. 

The word quarantine is derived from the Italian 
quarantines, meaning forty, and was originally applied 
to the period of detention of persons arriving at a port 
or city from a place where infectious diseases prevailed. 
The first quarantine regulations date from the four- 
teenth century, when certain measures against the 
introduction of the plague were enforced in the city of 
Florence. The period of detention during which the 
infected or suspected individuals were prohibited from 
holding intercourse with the inhabitants of the city 
was forty days, whence the name quarantine. In the 
succeeding century the authorities of Tenice, then at 
the climax of her power, instituted a system of quaran- 
tine, which formed the model of similar establishments 
until recent times. The penalties for infractions of the 
quarantine regulations were exceptionally severe. 

At the present day the word quarantine has lost 
its original significance. The ancient quarantine of 
detention has given place, theoretically at least, to a 
quarantine of observation. The old notions still keep 
a strong hold on the official mind however, and too 
much faith is still placed on the protective influence of 
a quarantine of detention. 

The object of quarantine is to prevent the introduc- 
tion into a city, state, or country, of contagious or 
infectious diseases. Obviously, the most certain way 
to effect this would be to absolutely prohibit all com- 
munion with persons and things from infected countries. 
But the demands of modern commerce and the necessi- 
ties of international intercourse clearly make this 
impracticable. No civilised community can afford to 



QUAKAXTIXL. 305 

isolate itself from the rest of the world for any consid- 
erable length of time. Measures designed to prevent 
the introduction of contagious diseases must be of a 
character not to interfere too greatly with travel and 
trade. 

The failure of the old system of detention to 
prevent the entrance of infectious diseases has caused 
some countries to abolish quarantine altogether, under 
the conviction that no quarantine system could effect 
the desired object. This is, however, a one-sided view 
of the matter. Quarantines can be made effectual safe- 
guards, if carried out in accordance with the modern 
knowledge of the diseases to be kept out. The modern 
notion of quarantine comprehends much more than the 
old. The following points illustrate its principal 
features. The inspecting officer must know : 

1. — The sanitary condition of the port of departure. 

2. — The original places of departure of passengers, 
crew, and cargo, and their sanitary conditions. 

3. — The sanitary condition of the vessel at the 
time of leaving port. 

4. — The sanitary history of the vessel, crew and 
passengers during the voyage. 

5. — The sanitary condition of the vessel and con- 
tents at the time of arrival and inspection. 

. The first, second and third conditions should be 
fully given in the consular bill of health. In order 
that this may be trustworthy, a competent medical 
officer should be attached to every consulate at places 
of embarkation or shipment. The duty of this medical 
officer should not be merely to inspect the ship and 
satisfy himself of her cleanliness before departure, but 
he should be required to keep himself informed of the 
sanitary history of all places whence passengers and 
their effects, or cargo come, in order that on his advice 
a clean bill of health may be refused to any vessel, 



306 TEXT-BOOK OF HYGIENE. 

which fails to come up to the required conditions. The 
medical attache might also be required to inspect the 
quarters and provisions of crews and passengers, in 
order to secure compliance with the laws in existence 
regulating these matters. The passengers and crew 
should be examined and if any are found suffering from 
contagious diseases they should not be permitted to 
proceed. No one should be allowed to set foot on a < 
ship who has not been previously vaccinated or pro- 
tected by an attack of small-pox. 

The sanitary condition of the vessel, crew and 
passengers during the voyage is ascertained from the 
log which is the official journal of the ship, and from 
the report of the ship's doctor, if there is such an 
officer on board. All cases of sickness or deaths which 
have occurred during the voyage, must be reported to 
the quarantine officer. 

The present condition of the vessel is ascertained 
by actual inspection at the quarantine station. Through 
this inspection the health of the crew and passengers, 
and the condition of the ship, as regards cleanliness, 
character and state of cargo, etc., are determined. 
With the knowledge obtained from these various sources, 
the quarantine officer can now act intelligently. 

If the sanitary history of the vessel, passengers, 
crew and cargo is good ; that is to say, if the vessel is 
clean, the passengers and crew healthy on embarkation, 
the cargo and passengers from a non-infected place, 
the port of departure healthy, and if no contagious 
disease appeared upon the vessel during the voyage, or 
is present at the time of inspection, the ship may be 
given 'free pratique ;' i. e. may be allowed to enter the 
harbor, discharge her cargo and passengers without 
danger of communicating infectious disease. 

If, however, the passengers and cargo come from 
a locality where a contagious disease is epidemic at the 



QUARANTINE. 307 

time of departure, or if such an epidemic exists at the 
port of embarkation and shipment, or has broken out 
during the voyage, the vessel must be declared infected, 
no matter whether she has a clean bill of health or not. 
The passengers and crew with their baggage are disem- 
barked, the latter disinfected, and the former de- 
tained on shore until the vessel has been disin- 
fected. All sick are removed to the quarantine hos- 
pital until the sickness comes to an end. After the 
ship and cargo have been thoroughly disinfected, 
for which purpose it may be necessary to unload the 
latter, the ship may be allowed to proceed to her wharf 
and discharge, or the cargo may be directly trans- 
shipped at the quarantine station. The passengers and 
crew must be detained at quarantine until the period 
of incubation of the disease quarantined against has 
passed, counting from the time of departure from the 
infected port, or from the appearance of the last case 
among them. Hence, if the vessel came from a yellow 
fever or cholera port, the period of detention need not 
exceed five days from time of departure, or the last 
exposure. 

Typhus fever may have a period of incubation 
lasting twelve days, and in small-pox, the usual period 
is two weeks, hence when these diseases are quarantined 
against, the detention of passengers must cover the 
time of these respective periods from the date of the 
last exposure. 

The proper equipment of a quarantine station com- 
prises residences for the quarantine officers and em- 
ployes, hospitals for the treatment of the sick, barracks 
to lodge passengers, boarding boats, wharves to secure 
vessels, warehouses in which freight and baggage can 
be stored, disinfecting chambers, and apparatus by 
means of which disinfectants can be forced into vessels 
and disinfecting chambers. 



308 TEXT-BOOK OF HYGIENE. 

A quarantine carried out in accordance with these 
principles might appropriately be called a quarantine 
of observation and disinfection, with incidental deten- 
tion. 

[More detailed information on quarantine may be 
found in the following works : 

Vanderpoel: Quarantine, in Buck's Hygiene and Public Health, Vol. 
II. General Principles affecting the Organisation and Practice of Quarantine. 
Public Health. Vol. I. Perry : Effectual External Sanitary Regulations 
Without delay to Commerce, Ibid. Baker : International Rules of Quaran- 
tine, Ibid. Vol. V.] 



CHAPTER XXII. 

VITAL STATISTICS. 

The registration of vital statistics comprises the 
recording of the births, marriages, deaths, and diseases 
of a city, state, or nation. In no other way can a 
knowledge of the health of the inhabitants of snch 
communities be obtained. For smaller, or special com- 
munities, such as armies, navies, schools, or special 
classes of workmen, the health status may be ascer- 
tained by direct methods, but for larger communities 
this is clearly impracticable, and the sanitarian is 
obliged to depend upon the census, and the registration 
of births, marriages and deaths. 

From a sanitary point of view, the most important 
object of a registration of vital statistics is to 'give 
warning of the undue increase of disease or death pre- 
sumed to be due to preventable causes, and also to 
indicate the localities in which sanitary effort is most 
desirable and most likely to be of use.'* 

The duty of registration should devolve upon the 
sanitary administration. Local and State boards of 
health would seem to be the most appropriate media for 
collecting information bearing upon births, diseases and 
deaths. It would seem also to be most appropriate to 
require the attending physicians to make reports of 
deaths and of cases of contagious disease to the health 
authorities. 

REGISTRATION OF DEATHS. 

The data entered upon the record of death should 
comprise the name, age, sex and color of decedent, 
nativity, descent, occupation, civil condition, date, 

*J. S. Billings: Kegistration of Vital Statistics; Am. Jour. Med. Sciences, 
Vol. LXXXV, p. 37. 



310 , TEXT-BOOK OF HYGIENE. 

place and cause of death. Under the heading ' descent,' 
the birthplace of each parent should be given. 
Occupation should be accurately specified. The place 
of death should indicate the exact locality, (number of 
street) where it occurred. Both proximate and predis- 
posing causes of the death should be entered, and any 
complications which may have influenced the fatal 
termination should be noted on the record. 

This record should be in the possession of the local 
health authority before a permit for the burial of the 
deceased is granted. If this is not insisted upon, 
the report will soon be omitted and the registration 
become defective. 



REGISTRATION OF BIRTHS. 

The collection of data for an accurate registration 
of births is much more difficult than the record of 
deaths. Instead of requiring physicians and midwives 
in attendance at the confinement to report births, it 
would be more equitable, and probably more effectual 
to compel the parents, under a penalty for failure, to 
record the birth of each child at the board of health. 
The items usually included in birth returns are : date 
and place of birth ; sex and color of child ; names of 
father and mother ; parents' nativity, and age ; and 
father's occupation. Sometimes the residence of the 
mother, number of children previously borne by the 
same mother, whether the child is legitimate or not, 
and various other details are also added. It is evident 
that for sanitary purposes most of this information is 
entirely irrelevant. It seems to the author that for the 
purpose of the sanitarian and medical statistician, the 
date and place of birth, sex and color of the child, and 
age, nativity, and occupation of both parents are 
sufficient. 



VITAL STATISTICS 311 

REGISTRATION OF MARRIAGES. 

The record of marriages is of no interest to the 
sanitarian. If, however, the registration could be 
made by a competent medical man, and the physical 
condition of the contracting parties noted, valuable 
deductions might be made in time, especially if the 
parties themselves and their offspring could be kept 
under observation for many years. This, however, is 
so manifestly impracticable that it barely deserves 
notice in this place. . 

REGISTRATION OF DISEASES. 

As has been seen in chapter XIX, a large class of 
diseases are communicable from one individual to 
another, either directly, by contact, or mediately, by 
infection. In large communities it is therefore import- 
ant that the sanitary authorities should possess infor- 
mation of the presence and prevalence of these diseases, 
in order that measures may be instituted for their re- 
striction. It is true that in most cases the registration 
of deaths gives but too mournful evidence of the more 
fatal of the diseases of this class, but destructive epi- 
demics could probably be frequently averted if pre- 
ventive measures could be enforced early. Besides, in 
the case of dengue and epidemic influenza, the death- 
rate is so small, that if the registration of deaths were 
alone depended upon, no evidence whatever might be 
attainable of the epidemic prevalence of such diseases. 

The registration of prevailing diseases is, there- 
fore, one of the most important duties of the registrar 
of vital statistics. Prompt notice of all cases of infec- 
tious, miasmatic or contagious diseases coming under 
their professional notice should be required of all phy- 
sicians. It is unquestionably just, however, that the 
physicians required to perform this duty should be 



312 TEXT-BOOK OF HYGIENE. 

properly compensated by the public, whose interests 
they serve. 

DEATH-KATE AND BIETH-EATE. 

In order to calculate the annual death-rate of a 
place, two facts are required to be known: first, the 
actual or estimated population (generally obtained from 
the census), and second, the number of persons who 
died within the district. The number of deaths is then 
divided by the population, which gives the death-rate 
for each individual for the year. " To find the death- 
rate per thousand, the death-rate as found above is 
multiplied by 1,000. Thus, the total number of deaths 
in the city of Baltimore during 1883 was 9,380, and 
the estimated population 408,520. The death-rate for 
the year was 22.96 per thousand, obtained as follows : 

To calculate the annual death-rate of a place for 
each thousand of the population from the returns for 
one week, the weekly population for the place is first 
ascertained, and then the total number of deaths for 
the week divided by the weekly population, and the 
quotient multiplied by 1,000. The following concrete 
example will render this clear : 

The exact number of weeks in a year is 52.17747. 
The total population is divided by this figure, giving 
the weekly population. This gives for Baltimore, as- 
suming the above estimate to be correct, a weekly pop- 
ulation of 7,829. For the week ending November 1, 
1884, the deaths in that city numbered 148. The 
annual death-rate per thousand, that is to say, the 
number of deaths in each thousand of population, if 
the same ratio were maintained throughout the year, 
is obtained as follows : 



VITAL STATISTICS. 313 

148 X 1,000 



18.9 per M. per annum. 



7,829 

Out of the above 148 deaths, 32 were from infec- 
tious diseases. To find the annual death-rate per 
thousand of population for this class of diseases, the 
same calculation is made, thus : 

32 X 1,000 f1 M • 

■ — ~ =4.1 per M. per annum. 

7,829 r * 

Or if the percentage of deaths of infectious dis- 
eases be desired, the procedure would be as follows: 

32 X 100 



148 



21.6 per cent, of the total deaths. 



Sixty-four of the decedents were under five years 
of age. The death-rate for this class is found in the 
same manner, for example : 

64X1,000 onw 

— „ onn — = 8.17 per M. per annum. 

or the percentage of these to the total deaths is found 
as in the last example. 

If it be desired to find the rate of infant mortal- 
ity, i. e. , the proportion of deaths among infants under 
one year of age to the total number of births for the 
same period, the following formula may be used. In 
the record above quoted the decedents under one year 
of age numbered 37 ; the total number of births for 
the same week was 157. Hence 

37 X 1,000 ooe „ ,, , ,. ,, 
— I = 235.7 per thousand births. 

or nearly one to four. 

Thirty-three of these 148 deaths were of colored 
persons. The death-rate of these to the total popula- 
tion is found in a similar manner to the above ; but if 
it is desired to ascertain the death-rate of the colored 



314 TEXT-BOOK OF HYGIENE. 

population alone, the weekly colored population must 
first be obtained and the rate calculated from this by 
the above formula. 

Birth-rates are found in a similar manner. The 
average age at death is ascertained by adding up the 
ages of all the decedents, and dividing the sum by the 
number of deaths. 

It will be evident on a little thought that there 
must be many sources of error in calculations based 
upon such uncertain data as are derived from the regis- 
tration of births and deaths as conducted in most cities 
in this country. Besides, the subject of vital statistics 
is essentially abstruse and requires no little readiness 
in mathematics to appreciate its profounder bearings. 
Hence, in the foregoing chapter no attempt has been 
made to penetrate beyond the immediate practical 
aspects of the questions involved. 

[To those desiring fuller information upon this 
subject, the following works are recommended : 

Curtis: Vital Statistics, in Buck's Hygiene and Public Health. Bil- 
lings: Registration of Vital Statistics, Am. Journ. Med. Sciences, Vol. 
LXXXV. Oldendorff : Morbilitets und Mortalitaets-Statistik, in Realen- 
cyclopaedie d. ges. Heilk. Bd. IX. Billings : Papers on Vital Statistici. 
Sanitary Engineer, Vol. VIII, IX.] 



Actinomycosis, 294. 
Adulteration of butter, 66. 
flour, 74. 
milk, 65. 
Air, absorption of aqueous vapor, 4. 
and health, 1. 

does not absorb heat when dry, 4. 
motion of, 5. 
Alcohol, constant use produces tissue de- 
generation, 81. 
does not counteract fatigue, 81. 
effects on bodily temperature, 81. 
brain, 79. 
digestion, 79. 
the circulation, 79. 
how excreted, 80. 
in disease, 80. 

increases predisposition to cer- 
tain diseases, 82. 
not necessary to persons in 
health, 81. 
Ale, 84. 

Alkaloidal beverages, 84. 
Alum to purify muddy water, 42. 
Ammonia as a cause of disease, 170. 
an impurity in water, 55. 
in the air, 16. 
Anilin vapor causing disease, 178. 
Animal diseases communicable to man, 

294. 
Antiseptics, 303. 
Anthrax, 296. 

Antiseptics and disinfectants, 298. 
Argo, malarial outbreak from using im- 
pure water, 43. 
Arsenic as a cause of disease. 183. 
Asiatic cholera, 266. 
Atmosphere, composition of, 2. 

effects of increased pressure 

of, 8. 
electrical and magnetic con- 
• ditions, 5. 

limit upward, 3. 
of the soil, 89. 
Atmospheric pressure and health, 6. 



Bacillus anthracis, 296. 
Bacillus typhoideus, 279. " 
Bacon on the Sweating Sickness, 248. 
Bacteria as causes of decomposition in 
the soil, 95. 
in atmospheric dust, 19. 
in drinking water, 37. 
Bacterium lineola, 96. 
Bacterium termo, 96. 
Baking. 79. 

Baltimore water supply, 30. 
Barometer, 3. 
Barometric pressure, 3. 
Barracks, 193. 

Bassi discovers fungus of muscardine, 236. 
Bathing, dangers from, 222. 

rules for, 221. 
Baths and bathing, 219. 
Baths, cold, 219. 

Russian, 219. 
Turkish, 219. 
tepid, 219. 
Beaumont on digestibility of eggs, 73. 
Beer, 83. 

adulteration of, 84. 
Bert, P. on effects of diminished atmos- 
pheric pressure, 6. 
Beverages containing alcohol. 79. 
Births, registration of, 310. 
Birth-rate, how obtained, 313. 
Blackstone river, pollution of, 34. 
Block hospitals, 144, 
Boccaccio on the plague, 244. 
Boiling, proper method of, 77. 
Bost»n city hospital, Cowles' experiments 

in ventilation, 147. 
Boston made land, carbonic acid in, 92, 
Boudin on outbreak of malarial fever 

from impure water, 43. 
Boussingault and Levy on composition of 

ground air, 90. 
Bovine tuberculosis, 295. 
Bowditch, H. I., on influenza in horses, 15. 
on soil-wetness and phthisis, 
99, 121. 



316 



Boylston, first American inoculator, 256. 

Brandy, 83. 

Brass-founder's ague, 177. 

Brauell on bacteria of splenic fever, 237. 

Bread, 73. 

characters of good, 74. 
Broad Street pump outbreak of cholera,48. 
Broiling, 79. 

Bromine vapors causing disease, 174. 
Brotherhood of the Cross, 245. 
Brown stout, 84. 
Buda-pesth, carbonic acid in ground 

air, 92. 
Buchan and Mitchell, relations of weather 

to disease, 11. 
Buchanan on the advantages of the earth 
closet, 111. 
effects of drainage in dimin- 
ishing consumption, 99. 
results of sanitary improve- 
ments, 122. 
typhoid fever from impure 
water, 47. 
Buhl on relation of ground-water oscil- 
lations to typhoid fever, 98. 
Burial grounds, supposed dangers from, 

233. 
Butter, 64. 

as an article of food, 66. 
sophistication of, 66. 
Butterine, 66. 

o 

Cabiadis on causes of the plague, 248. 
Cable, G. W. on prison mortality, 211. 
Cagniard de la Tour, observations on 

yeast plant, 236, 
Calcutta, ' black hole * of, 14. 

cholera in, 97. 
Camp diseases, 195. 
hygiene, 190. 
Canned meats, poisoning by, 72. 
Carbo-hydrates, 61. 

necessary constituents 
of food, 59. 
Carbon bisulphide as a cause of disease, 

173. 
Carbon, its conversion into carbonic 

aoid, 2. 
Carbonic acid gas as a source of disease, 

172. 
Carbonic acid in air, how detected, 19. 

of school rooms, 13. 
soda-water man- 
ufactories, 13. 
cess-pools, 21. 
ground-air an indication 
of impurity, 93. 



Carbonic acid, in the air of a room, 25. 

normal proportion in at- 
mosphere, 12. 
proportion in Boston made 

land, 92. 
source in decomposition in 
the soil, 13. 
Carbonic oxide, how detected in the air,20. 
Carbonic oxide poisoning, 16, 171. 
Carburetted hydrogen, 16. 
Catarrhal affections and dry air, 11. 
Caterham epidemic of typhoid fever, 45. 
Cemeteries not sources of infectious dis- 
eases, 238. 
Cemetery air, 18. 
Cerebro-spinal meningitis, prevention of, 

291. 
Cerebro-spinal meningitis, causes of, 290. 
Cerebro-spinal meningitis, history of, 289. 
Chambers, J. \V., on polluted hydrant 

water, 49. 
Cheese as an article of food, 67. 
Chicago water supply, 30, 36. 
Chloride of palladium, a test for car- 
bonic oxide, 20. 
Chlorine as a cause of disease, 170. 

or chlorides as impurities in 
water, 54. 
Chocolate, 86. 

Cholera and ground-water oscillations, 97. 
Asiatic, history of, 266. 
causes of, 271. 
from impure water, 48. 
in Buda-pestb, 98. 
prevention of, 274. 
Cider, &3. 

Cisterns as storage reservoirs, 31. 
Civilian camps, 199. 

Clark's non-freezing hydrant, descrip- 
tion. 50. 
scale, 41. 
Climate, effects on amount of food re- 
quired, 60. 
Clothing, how made non-inflammable, 230. 
materials, 217. 
objects of, 227. 
of the soldier, 192. 
Coal dust causing disease, 180. 
Coca, 86. 
Coffee, 85. 

adulteration of, 85. 
how it should be made. 77. 
Color-blindness among sailors, 207. 
Color of clothing, 228. 
Compressed air as a cause of disease, 1S6. 
Condiments, 76. 

Consumption, relation of soil-moisture 
to, 99. 



INDEX. 



317 



Contagion and infection, 240. 

Cooking of food, 77. 

Copper vapors causing disease, 177. 

Cowles, E. experiments on ventilation. 

147. 

Cremation, 234. 
Croup and season, 12. 
Curschmann, on period of infection in 
small-pox, 253. 



Da Costa on irritable heart, 217. 
Damp walls in houses, how rectified, 129. 
Davaine on bacteria of splenic fever, 237. 
Deaths, registration of, 309, 
Death-rate, how obtained, 312. 
De Bary on parasitic diseases, 237. 
De Chaumont on ground-water level, 97. 
quantity of water re- 
quired, 29. 
Defoe on the plague, 245. 
Dengue, causes of, 288. 
history of, 287. 
Diarrhoea and season, 11. 

dysentery as camp dis- 

from sewer air, 18. 
Diarrhceal diseases from great heat, 9. 
Dickson on causes of the plague, 248. 
Diphtheria and season, 12. 
causes of. 286, 
history of, 285. 
prevention of, 286. 
Diseases.from absorption of irritating or 
poisonous substances, 183. 
a constrained attitude, 188. 
excessive use of certain 

organs, 187. 
exposure to violence, 188. 
impure water, 42. 
inhalation of irritant gases 

or vapors, 169. 
poisonous dust, 179. 
variable temperature and 
pressure, 186, 
of hot climates, 9, 
school life, 159. 
on ship-board, 206. 
Diseases, registration of, 311. 
Disinfectants, 298. 
Disposal of the dead, 231. 
Distillation as a source of water-supply, 

39. 
Distilled water.contamination by lead, 39. 
Drainage, 101. 

differs from sewerage, 101. 
Drinking water in Memphis, 32. 



Drowning, how to avert, 323. 
Dwelling of the soklitr, 198. 
Dwellings, cause of moisture in walls, 129. 

drainage of site, 127. 

heating arrangements, 13C. 

interior arrangement, 129. 

interior coating of walls, 130. 

lighting of, 130. 

material for construction, 127. 

proper arrangements for ven- 
tilation. 129. 

site and character of soil. 133, 

size of rooms, 129. 

should not be occupied until 
dry, 128. 

water supply, 133. 

Eagle sanitary closet, 108. 
Earth closets, 110. 
Eggs as food, 73. 
Electric light, 132. 
Electrical condition of the air, 5. 
Emmerich on the effects of drinking pol- 
luted water, 45. 
Endemic, 241. 
Entombment, 334. 
Epidemic diseases, history of, 243.' 
influenza, history of. 288. 
what constitutes an, 241. 
Erbswurst, 75. 
Ergot in grain, 75. 

Erismann on Liemur's system of sewer- 
age, 112. 
progressive myopia among 
school children, 160. 
Eulenburg, M., on spinal curvature in 

school children, 161. 
Evans, T. B., on pneumonia among work- 
men in grain elevators, 183„ 
Exercise and training, 214. 
Eyesight of school children, 159. 



Fats, 61. 

necessary constituents of food, 59. 

Farcy, 297. 

Field's flush tank, 115. 

Fire-damp, 16. 

Fleck on ground air, 91. 

Florschutz on bad light and improper 
seats as causes of nearsight in school 
children, 161. 

Flour, adulteration of, 74. 

Fodor on ground air, 91. 

Folsom, C. F., on typhoid fever from im- 
pure water, 47. 



318 



Food, 58. 

diseased meat not to be used as, 69. 
fats and carbo-hydrates necessary 

constituents of, 59. 
greater quantity required when 
exposed to low temperature, 62. 
more required by the young, 6a. 
of the soldier, 191. 
physical exertion demands increas- 
ed supply, 61. 
proteids necessary constituents of, 

59. 
quantity and character necessary, 

58. 
relation to moral and mental con- 
ditions, 62. 
salts necessary constituents of, 59. 
water as a necessary constituent, 
58. 
Foods of animal origin, 63. 

vegetable origin, 73. 
Forwood, W. S., on diseases in canning 

houses, 169. 
Free pratique, 306. 
Freezing as a means of purification of 

water, 37. 
Fresh air inlet of house drain, 140. 
Frost bite, 10. 

Fruits often useful as necessary food, 76. 
Fry, Elizabeth, prison reformer, 209. 
Frying, proper method of, 78. 

a- 

Gardner, J. T., on pail-closet system of 

Rochdale and Manchester, 108. 
Gas. danger of poisoning, 131. 
Gaseous disinfectants, 302. 
Germ theory of disease, 236. 
Germicides, 298. 

Gihon, A. L., on epidemic of parotitis on 
shipboard, 207. 
high temperature in en- 
gine rooms of ships. 206. 
the habits of the sailor, 

200. 
ship ventilation, 27. 
Gillaume on spinal curvature in school 

children, 161. 
Gin, 82. 
Glanders, 297. 

Goitre from hard water, 42. 
Green vegetables, 76. 
Griffith, S. H., on ground air, 91. 
Ground air, 89. 

from Lybian desert, 93. 
how to prevent it from as- 
cending into houses, 92. 
movements of, 92. 



Ground air permeates houses, 92. 
Ground water, 94. 

as a source of pollution of 
drinking water, 95. 
Gruby on parasitic skin diseases, 237, 
Guarana, 86. 
Gymnastic exercises in schools, 159, 

h: 

Habitations and disease, 120. 
Hammond, W. A., effects of polluted air 

on mouse, 14. 
on inefficiency of sol 

diers, 190. 
Hardness of water, 41. 
Hart, Ernest, on epidemic diseases due to 

polluted water, 47. 
Hearing, defective, in school children, 166. 
Henle on the germ theory. 236. 
Highest permanently inhabited places, 8. 
Hippocrates on the effect of water from 



soil, 88. 
History of Asiatic cholera, 266. 
dengue, 287. 
diphtheria. 285. 
epidemic diseases, 243. 

influenza, 288. 
relapsing fever, 277. 
scarlet fever and measles, 2S4. 
small-pox, 250. 
the sweating sickness, 24S. 
typhoid fever, 279. 
typhus fever, 280. 
yellow fever, 281. 
Hopper closets, 135. 

Hospital administration and manage- 
ment, 151. 
buildings. 142. 

classification of patients, 152. 
construction, 142. 
duties of Superintendent, 151. 
full record of cases to be kept, 

152. 
heating and ventilation. 145. 
inside angles should be round- 
ed, 148. 
interior walls should be smooth 

and plain, 146. 
isolation of floors and wards, 

147. 
kitchen should be in separate 

building, 150. 
must contain bath room and 

lavatory, 148. 
nurses' room, 149. 
operating room, 153. 
prompt removal of excreta, 14S. 



319 



Hospital resident physician, 151. 

should have dead-house, 150. 

disinfecting chest, 149. 

site, 142. 

space per bed, 143. 

special baths, 149. 

traps and sewer connexions, 
149. 

urinals not necessary, 148. 

ventilation, Neirnsee's plan, 
147. 

walls need not be impervious, 
146. 

ward-kitchen, 150. 

water-closets, 148. 

water-supply, 149. 
House drain, 139. 

drainage, 133. 
Howard, John, prison reformer, 209. 
Humidity, absolute and relative, 5. 

and health, 10. 
phthisis, 10. 
Humus, 89. 

Hydrants as sources of impure water, 49. 
Hydrochloric acid fumes, 169, 
Hydrophobia, 295. 



Ioe, impure, at Newport, 37. 

impurities in, 37. 
Illuminating gas poisoning, 16. 
Impure air and phthisis, 15. 

ice at Newport and Rye Beach, 37. 
Impurities in cistern water, 32. 
rain water, 32. 
river water, 33. 
stored water, 36. 
water, 40. 
well water, 38. 
Industrial hygiene, 165. 
Influenza, causes of, 289. 

in horses, and sanitary condi- 
tion of stables, 76. 
Initial air space, 23. 
Inoculation of small-pox virus, 254. 
Inorganic proximate principles , 61. 
Intemperance increases gravity of vari- 
ous diseases, 82. 
Interment, 231. 

on the battle-field, 235. 
Iodine vapors causing disease, 174. 



Jenner, E., observations on vaccination, 

258. 
Jesty, B., first inoculated cow-pox, 257. 



Johns Hopkins hospital, 143. 
Johnson, Jno. G. on poisoning by canned 
food, 72, 

Keen, W. W., window ventilating ar- 
rangement, 27. 
Kidder, J. H. on ground air, 91. 
Koch on bacteria of splenic fever, 237. 
Koumyss, 84. 
Kuehn on parasitic diseases, 837. 



Lakes as sources of water supply, 36. 

Lamp explosions, 131. 

Lancisi on malarial fevers, 88. 

Lead poisoning among artisans, 175. 

Leather as clothing material, 228. 

Lee, J. G. on suicide and weather, 12. 

Leguminous seeds as food, 75. 

Lewis and Cunningham, researches on 
ground air, 91. 

Liernur's pneumatic system of sewage 
removal, 111. 

Limit of solids allowable in drinking 
water, 41. 

Lind on purification of water, 52. 

Linen clothing, 228. 

Lortet on symptoms from diminished at- 
mospheric pressure, 7. 

Low temperature and health, 10. 

.m: 

MacPherson on cholera in India, 97. 

Made lands in cities, 127. 

Malarial fever from impure water, 43. 
fevers as camp dissases, 197. 

Malmsten on parasitic skin diseases, 237. 

Marine hygiene, 200. 

Marriages, registration of, 311. 

Marshall, John, on outbreak of cholera 
from pump water, 48. 

Massachusetts, rivers, pollution commis- 
sion, 34. 

Mate, 86. 

McClellan, E., on epidemic cholera, 272. 

McSherry, R., on diseases from eating 
oysters, lobsters and crabs out of sea- 



s, history of, 284. 
Meat, governmental inspection of, 72. 

rendered unfit as food, 69. 

varieties used as food, 68. 
Meneville on silkworm disease, 237. 
Mercurial poisoning among artisans, 176. 



320 



Metallic dust causing disease, 180. 
Methods of physical training, 515. 
Michigan method of restoring the appa- 
rently drowned, 223. 
Milzbrand, S9S. 

Microscopic examination of air, 21. 
Military hygiene, 190. 
Milk, 03. 

adulteration of, 65. 

as a cause of disease, 65. 

as a cause of typhoid fever, 47. 

chemical changes in, 64. 

composition of, 63. 

specific gravity of, 64. 
Mineral dust causing disease, 181. 
Mitchell, S. Weir, account of case of Capt. 

Catlin, 11. 
Moleschott's standard diet, 59. 
Montagu, Lady M. W. on small-pox inoc- 
ulation, 254. 
Morris, J. on typhoid fever from impure 

water, 50. 
Mortality in passenger vessels, 203. 
Moule's earth closet, 110. 
' Mountain Sickness,' 6. 
Munich, ground water oscillation, 95. 
Mycosis intestinalis, 296. 

1ST 

Nearsightedness among school-children, 

160. 
Nebraska, impure river water in, 33. 
Neirnsee, J. K., plan of hospital ventila- 
tion, 147. 
Neuralgia and weather, 11. 
New England, pollution of rivers in, 34. 
Nichols, A. H. on epidemics from impure 
ice, 37. 
Wm. K., carbonic acid in air of 

school room, 13. 
W. R., on ground air, 91. 
Nitrates and nitrites in water, 38. 
Nitric acid fumes, 169. 

or nitrates as impurities in 
water, 54. 
Nitrogen in atmosphere, 2. 
Nitrous acid or nitrites as impurities in 
water, 54. 



Obermeier on cause of relapsing fever, 277. 
Occupations, hygiene of, 165. 

prejudicial to health, 168. 
Oleomargarine, 66. 
Ophthalmia as a camp disease, 198. 



Organic impurity in air, how detected, 20. 

matters in water, tests for, 55. 
Organisms in water, 40. 
Overcrowding and mortality, 120. 
Over Darwen epidemic of typhoid fever, 
'47. 

Over-exertion, 217. 
Oxygen and carbonic acid, their relations 

in ground air, 90. 
Ozone, 6. 

IP 

Pan closet, 134. 

Pandemic, 341. 

Paraguay tea, 86. 

Parasitic diseases from impure water, 44. 

Parkes' estimate of sewage discharged 

per person, 103. 
Parkes on healthy and unhealthy soil, 123. 
quantity of water required, 39. 
the use of alum to purify mud- 
dy water, 43. 
Parkes' rules for arrangement of ventila- 
tion, 36. 
Passengers on vessels, 203. 
Pasteur on silkworm disease, 337. 

splenic fever, 100. 
Pavilion hospitals, 144. 
Pengra, C. P., experiments on purifica- 
tion of water by freezing, 37. 
Percivall, O. P., on defective hearing in 

school children, 161. 
Pettenkofer on carbonic acid in air of 
school room, 13. 
causation of cholera, 

275. 
ground air, 91. 

from Lybian 
desert, 93. 
water level in 
cholera and 
typhoid fever, 
97. 
relations of ground 
water oscillations to 
typhoid fever, 98. 
respirable limit of car- 
bonic acid, 13. 
Petroleum in drinking water, 40. 

vapor causing disease, 175. 
Phosphorus necrosis, 184. 
Physical training, 215. 

effects of exercise, 314. 
Phthisis and season, 13. 

as a oamp disease, 197. 
Pike's Peak, £. 
Plague, causes of, 346. 
history of, 343. 
prevention of, 348. 



321 



Plunger closets, 135. 

Pneumonia of cotton operatives, 182. 

Poisonous gases and vapors in various 

occupations, 169. 
Pollendei'on bacteria of splenic fever, 237. 
Polluted air, fatal effects of, 14. 
Pollution of rivers by sewage, 34. 
Ponds as sources of water supply, 36. 
Porter, 84. 
Potassium bichromate causing, disease, 

185. 
Potatoes as food, 75. 
Precipitation as a source of water-supply, 

33. 
Pressure of the atmosphere, 3. 
Prison hygiene, 209. 
Prisoners, classification of, 209. 
Prisons, mortality in, 211. 

sanitary requirements of, 212. 
Privies, disinfection of contents, 105. 
how to be constructed, 104. 
methods of removal of .contents, 

106. 
should be ventilated, 105. 
Privy-vaults, how to remove vitiated air, 

21. 
Privy-wells, objections to them, 107. 
Prize-fighters' diet, 59. 
Proportion of different food-stuffs in 

standard diet, 59. 
Propositions regarding cholera, 273. 
Protective inoculations, 238. 
Proteids, 61. 

necessary constituent of food, 
59. 
Ptomaines in decomposing meat, 71. 
Public baths, 225. 
Putrefaction in rain water, 32. 
Putrefaction may act as a disinfectant, 



Q, 



Quarantine, 304. 

Quarantine of detention, 305. 

Quarantine station, proper equipment 
of, 307. 

Quinan, J. R., on introduction of inocu- 
lation into America, 
256. 
introduction of vacci- 
nation into America, 
258. 

Quinine vapors causing disease, 185. 

IR, 

Rabies, 295. 
Radiation of heat, 4. 
Rag-sorters' disease, 185. 



Rain water, 33. 
Recruiting, 191. 
Registration of births, 310. 
deaths, 309. 



marriages, 811. 
Relapsing fever, 277. 

Remseu, Ira, on cause of cucumber taste 
and odor in water, 36. 
determination of the or- 
ganic matter in the air, 



Rennie on causes of the ] 
Requirements of modern quarantine, 305 
Rice as food, 75. 

Rivers as sources of water-supply, 33. 
River water, organic matter in, 33. 

purification of, 35, 
Roasting, Sir Henry Thompson on, 78. 
Rochdale system of removal of sewage, 

107. 
Rubber clothing, 228. 
Rum, 82. 
Rye beach, effects of impure ice at, 37. 



Sailor life, 200. 

Sailors, physical examination of, 207. 
Salts necessary constituents of food, 59. 
Sanitary arrangements, official supervi- 
sion of, 140. 
associations, 141. 
Scarlet fever and season, 11. 
history of, 284. 
Schlagintweit on effects of diminished 

atmospheric pressure, 7. 

Schoenbein's test for ozone, 6. 

Schcenlein on parasitic skin diseases, 237. 

School-children and defective hearing,161. 

causes of myopia of, 160. 

digestive derangements 

among, 162. 
frequency of spinal cur- 
vature among, 161. 
nervous disorders among, 

162, 
vision of, 159. 
School diseases, 159. 
School furniture, 157. 
School-houses, construction of, 154. 

proper lighting of, 155. 
School-rooms, carbonic acid in air, 13. 
model, 155. 

proportion of window to 
floor-space, 156. 
Schools and contagious diseases, 163. 
diphtheria, 163. 



INDEX. 



Schools as causes of pulmonary consump- 
tion, 163. 
position of blackboards, 138. 
proper construction of desks, 157. 
time to be devoted to study, 158. 
water closets and privies, 157. 
Schwann's observations on yeast plant, 

236. 
Scurvy in arctic regions, 10. 

as a camp disease, 198. 
Sea bathing, 230. 

Seaton on protection conferred by vacci- 
nation, 261. 
Self purification of river water, 35. 
Selmi on poisonous character of pto- 
maines, 72. 
Sewage disposal, privy system, 104. 
final disposal of, 118. 
in river water, 34. 
irrigation, 118. 
pollutes ground water and ground 

air, 103. 
removal of, 103. 

cost of by the pail-closet 

system, 109. 
earth and ash closets, 

110. 
pail system. 107. 
pneumatic system of 

Liernur. 111. 
water carriage system, 
113. 
Sewerage by water carriage, 113. 
combined system, 113. 
separate system, 114. 
Sewers, size of, 114. 

ventilation of, 115. 
Sewer air, 17. 
Sexton, S., on defective hearing in school 

children, 161. 
Sheep-pock, 294. 

Ship ventilation, Gihon's plan, 27. 
Ships as habitations, 203. 

should be clean and well ventilated, 
205. 
dry, 204. 
seaworthy, 204. 
Siguatera, a disease from eating poison- 
ous fish, 71. 
Signal service observations, 1. 
Silk clothing, 228. 
Skim milk, 64. 
Small-pox and season, 11. 
causes of, 252. 
history of, 250. 
restriction of. 266. 
Smart, Chas., chemical examination of 
drinking water, 32. 



Smart, Chas., on ' mountain fever,' 33. 

organic matter in river 
water, 33. 
Smith, R. A., experiments on pollution of 

air by respiration, 14. 
Smith's minimetric test for carbonic acid, 

19. 
Snow and ice as sources of water-sup- 
ply, 39. 
blindness, 10. 
Soap test for hardness of water, 41. 
Soil and health, 88. 
atmosphere, 89. 

impurities spreading disease, 96. 
moist stratum of, 95. 
moisture and bovine tuberculosis, 100. 
permeability of, influencing composi- 
tion of ground air, 91, 
physical and chemical characters, 88. 
conditions of, probably pro- 
ductive of animal diseases, 
100. 
water, 94, 
pipe, 138. 
Soils, healtby and unhealthy, 133. 
Soldier life, 190. 
Spirillum Obermeieri, 277. 
Spinal curvature caused by improper po- 
sition of the body, 162. 
caused by improper seats 

and desks, 162. 
in school children, 161. 
Splenic fever, 396. 

Spongilla fluviatilis, as a source of cucum- 
ber taste in water, 36. 
Springs as sources of water supply, 38. 
Standard diet, 59. 
Statistics, vital, 309. 

Sternberg, 6. 31., experiments on disin- 
fectants, 298. 
St. Louis water supply, 30. 
Storm water, how removed, 117. 
Suicide and season, 12. 
Sulphur-compounds in water, 40. 
Sulphuretted hydrogen as a cause of dis- 
ease, 173. 
in the air, 16. 
Sulphuric acid or sulphates as impurities 

in water, 55. 
Sulphurous acid gas as a cause of disease, 

169. 
Sunstroke due to intense heat and Tow 
humidity, 9. 
in Cincinnati, 9. 
promoted by use of alcohol, 82. 
Sweating sickness, causes of, 249. 
history of, 248. 
Swell-head in cattle. 295. 



INDEX. 



Swill-milk, 66, 

syphilis, cause of, 293. 
Syphilis, history of, 391. 



Table of proteids and fats in various 
meats, 68. 
showing composition of legumi- 
nosa, 75. 
deaths in U. S. Army, 196. 
effects of physical exer- 
cise, 217. 
relations of occupation 

to mortality, 166. 
relative proportions of 
nitrogenous to non-ni- 
trogenous principles, 
60. 
Tapeworm from impure drinking water, 

44. 
Tea, 86. 

adulteration of, 86. 
Teachers, examination in hygiene before 

appointment, 164. 
Temperature and health, 9. 

of the atmosphere, 4. 
Tents, 194. 

Tests for impurities in the air, 19. 
Thorne on outbreak of typhoid fever from 

polluted water, 45. 
Tobacco, 86, 

diseases produced by, 87. 
dust causing disease, 182. 
Toilet's system of barrack construction, 

193. 
Tracy, R. S., on diseases of tobacco work- 
ers, 182. 
Traps in water-closets, 137, 
Trichina spiralis, 70. 
Tuberculosis in cattle, 295. 
of cows, 70. 
Tulasne on parasitic diseases, 237. 
Turner on high temperature in engine- 
rooms of ships, 206. 
ventilation of ships, 206. 
Turpentine vapor causing disease, 175. 
Tyndall on atmospheric dust, 18. 
Type, proper size for school-books, 161. 
Typhoid fever and season, 11. 

as^a camp disease, 107. 
causes of, 297. 
from impure water, 45. 
infected milk, 47. 
history of, 278. 
prevention of, 280. 
Typhus fever, as a camp dise Re, 198. 
causes of. 270. 



Typhus fever, history of, 280. 

prevention of, 281. 

TJ 

Utah, impure river water in, 33. 

Vaccinal syphilis, 266. 
Vaccination, 257. 

complications of, 264. 
methods of performing. 263. 
proper age at which to per- 
form, 261. 
protective power of, 260. 
symptoms of, 259. 
Vaccine virus, Cory's experiments on co- 
incident inoculation of 
syphilis, 263. 
objection to use of ani- 
mal, 262. 
objections to use of hu- 
manised, 262. 
Vaccinia, nature of, 259. 
Valve closets, 135. 
Vegetable dust causing disease, 182. 
Ventilation, 22. 

and epidemic diseases, 15. 

heating of hospitals, 145. 
by diffusion, 24. 
perflation, 24. 
uaequal pressure, 24. 
natural and artificial, 24. 
objects of, 23. 

of hospitals, Neirnsee's plan, 
147. 
ships, 205. 
traps, 138, 
Virchow on relations o 
oscillations to typhoid 1 
Vitruvius on healthy site for a dwelling. 

Vital statistics, 309. 

Voit on the relative value of starch as 
food, 59. 



ground-water 



w 



Waring, G. 



removal of sewage by 
separate system, 114. 
expanding upper end 
of soil-pipe, 139. 
Wash-out closets, 136. 
Water a necessary constituent of food, 58. 
as a cause of goitre, 42. 

intestinal diseases, 



324 



Water as a source of animal parasitic dis- 
eases, 44. 
cholera. 48. 
typhoid fever, 45. 
characters of good, 39. 
danger of contamination by lead, 

51. 
determination of ammonia, 55. 
chlorine, 54. 
nitric acid, 54. 
nitrous acid, 54. 
distribution of, 51. 
freezing as a means of purification, 



from marshes as a source of mala- 
rial diseases, 43. 
impure, diseases from, 42. 
impurities in, 40. 
methods of collecting and storing, 

31. 
objections to use of hard water for 

domestic purposes, 43. 
permanent hardness of, 41. 
purification by alum. 42, 53. 
boiling. 52. 
deposition, 51. 
filtration, 51. 
passing through 

air, 52 
potassium perman- 
ganate, 53. 
vegetable astrin- 
gents, 53. 
quantity required by human beings, 

29. 
removable hardness of, 41. 
significance of various impurities, 

56. 
sources of, 31. 



Water, storage and purification of, 51. 
sulphuric acid as impurity in, 55. 
tests for hardness, 41. 
impurities, 53. 
organic matters in, 55. 
total hardness of, 41. 
waste in supply, 30. 
Water closets, 134. 

meters as means of checking 

waste, 30. 
service, inspection of, 33. 
supply, allowance for other than 
drinking and domestic 
purposes, 30. 
for closets, 137. 
Waterhouse, and the introduction of vac- 
cination into America, 258. 
Wells as sources of water supply, 38. 
Whiskey, 82. 

Whooping cough and season. 12. 
Wind, 5. 

Winds, dry and moist, 5. 
Wine, 83. 
Woodworth, J. M. on epidemic cholera, 

272. 
Wool clothing. 238. 
Wyoming, impure river water in, 33. 



Yellow fever, causes of, 283. 
history of, 281. 
prevention of, 284. 



Zinc vapors causing disease, 177. 




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